=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801946181
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDA J. NIGHTINGALE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2007
-----------------------------------------------------
Last Update Date | 09/07/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1020 12TH AVE SE
-----------------------------------------------------
City | DYERSVILLE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-581-2508
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1020 12TH AVE SE
-----------------------------------------------------
City | DYERSVILLE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52040-1919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-581-2508
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 14351
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------