MEDICARE: LINDA R VADERS CNP

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	363L00000X	Nurse Practitioner	COA10798 NP	OH
2	363LA2200X	Adult Health Nurse Practitioner	APRN.CNP.10798	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1811945041	OTHER	OH	NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811945041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA R VADERS CNP

Provider Business Mailing Address
First Line	:	1611 W QUEEN ST
Second Line	:
City	:	EDENTON
State	:	NC
Zip	:	27932-9210
Country	:	US
Telephone Number	:	765-412-1448
Fax Number	:

Provider Business Practice Location Address
First Line	:	3700 SOUTHERN BLVD STE 401
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45429-1265
Country	:	US
Telephone Number	:	855-500-2873
Fax Number	:	937-281-3913

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	10/03/2025

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Directions to “ LINDA R VADERS CNP” Practice Location

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