1225278674 NPI number — JESSICA ANNE LINDE PHARMD

Table of content: JESSICA ANNE LINDE PHARMD (NPI 1225278674)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225278674 NPI number — JESSICA ANNE LINDE PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LINDE
Provider First Name:
JESSICA
Provider Middle Name:
ANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225278674
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
927 TRETTEL LANE
Provider Second Line Business Mailing Address:
FOND DU LAC HUMAN SERVICES DIVISION
Provider Business Mailing Address City Name:
CLOQUET
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-878-2185
Provider Business Mailing Address Fax Number:
218-878-3755

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
927 TRETTEL LANE
Provider Second Line Business Practice Location Address:
FOND DU LAC HUMAN SERVICES DIVISION
Provider Business Practice Location Address City Name:
CLOQUET
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-878-2185
Provider Business Practice Location Address Fax Number:
218-878-3755
Provider Enumeration Date:
02/25/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  119366 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)