=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376581710
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDA JO VOLNESS APRN, CNS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2006
-----------------------------------------------------
Last Update Date | 10/28/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1316 23RD ST S
-----------------------------------------------------
City | FARGO
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58103-3707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-478-0333
-----------------------------------------------------
Fax | 701-478-0434
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2309
-----------------------------------------------------
City | FARGO
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58108-2309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-478-0333
-----------------------------------------------------
Fax | 701-478-0434
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 364SP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
-----------------------------------------------------
License Number | R21956
-----------------------------------------------------
License Number State | ND
-----------------------------------------------------