1619959376 NPI number — LINDA MARIE PLUSH FNP

Table of content: LINDA MARIE PLUSH FNP (NPI 1619959376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619959376 NPI number — LINDA MARIE PLUSH FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PLUSH
Provider First Name:
LINDA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
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:
1619959376
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
38660 MEDICAL CENTER DRIVE #A130
Provider Second Line Business Mailing Address:
SUMMIT URGENT CARE
Provider Business Mailing Address City Name:
PALMDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93551
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-273-7100
Provider Business Mailing Address Fax Number:
661-208-4885

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
38656 MEDICAL CENTER DRIVE #C SUITE
Provider Second Line Business Practice Location Address:
SUMMIT URGENT CARE
Provider Business Practice Location Address City Name:
PALMDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-273-7100
Provider Business Practice Location Address Fax Number:
661-208-4885
Provider Enumeration Date:
11/17/2005

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: 364SA2200X , with the licence number:  CNS 159 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: FNP 11365 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: FNP 11365 . This is a "FAMILY NURSE PRACTITIONER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: RN 294762 . This is a "RN LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 11365 . This is a "PRACTITIONER FURNISHING" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CNS 159 . This is a "CLINICAL NURSE SPECIALIST" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".