MEDICARE: LINDA KILLINGBECK 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	163WS0200X	School Registered Nurse	215565	AZ

General Provider Information

NPI Number	:	1457834509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA KILLINGBECK RN

Provider Business Mailing Address
First Line	:	5048 E DUANE LN
Second Line	:
City	:	CAVE CREEK
State	:	AZ
Zip	:	85331-2311
Country	:	US
Telephone Number	:	651-226-9666
Fax Number	:

Provider Business Practice Location Address
First Line	:	5802 E DOVE VALLEY RD
Second Line	:
City	:	CAVE CREEK
State	:	AZ
Zip	:	85331-5246
Country	:	US
Telephone Number	:	480-575-2445
Fax Number	:

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

Provider Enumeration Date	:	09/13/2018
Last Update Date	:	09/13/2018

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