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NPI Code Detail

MEDICARE: LINDA LOU MCCLINTOCK ARNP

MEDICARE: LINDA LOU MCCLINTOCK ARNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerA088620IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
115484OTHERIAWELLMARK

General Provider Information

NPI Number : 1134171762
Entity Type Code : Individual
Provider Name (Legal Business Name) : LINDA LOU MCCLINTOCK ARNP
Provider Business Mailing Address
First Line : 217 CAYUGA ST
Second Line :
City : STORM LAKE
State : IA
Zip : 50588-2522
Country : US
Telephone Number : 712-732-0194
Fax Number : 712-213-0186
Provider Business Practice Location Address
First Line : 630 ONTARIO ST
Second Line :
City : STORM LAKE
State : IA
Zip : 50588-1845
Country : US
Telephone Number : 712-213-0109
Fax Number : 712-213-0186
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2006
Last Update Date : 07/08/2007

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