1073630745 NPI number — MRS. LINDA B WATERWORTH ANP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073630745 NPI number — MRS. LINDA B WATERWORTH ANP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WATERWORTH
Provider First Name:
LINDA
Provider Middle Name:
B
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ANP
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:
1073630745
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1401 JOHNSTON WILLIS DR
Provider Second Line Business Mailing Address:
SUITE 4500
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23235-4730
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-320-1355
Provider Business Mailing Address Fax Number:
804-560-3531

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 JOHNSTON WILLIS DR
Provider Second Line Business Practice Location Address:
SUITE 4500
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23235-4730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-320-1355
Provider Business Practice Location Address Fax Number:
804-560-3531
Provider Enumeration Date:
03/26/2007

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: 363LA2200X , with the licence number:  0001078920 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0001078920 . This is a "STATE LISCENSE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com