MEDICARE: LINDA O'NEAL RN

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
1	163W00000X	Registered Nurse	196469	CO

General Provider Information

NPI Number	:	1164790945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA O'NEAL RN

Provider Business Mailing Address
First Line	:	1015 LOCHMORE PL
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-6453
Country	:	US
Telephone Number	:	970-443-2923
Fax Number	:

Provider Business Practice Location Address
First Line	:	2211 S COLLEGE AVE
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-1489
Country	:	US
Telephone Number	:	970-237-6339
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2011
Last Update Date	:	12/07/2011

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