Provider Demographics
NPI:1124161609
Name:MORAN, LINDA MAE (CERT SURG 1ST ASST)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:MAE
Last Name:MORAN
Suffix:
Gender:F
Credentials:CERT SURG 1ST ASST
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Mailing Address - Street 1:275 WEDGEWOOD PLACE
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001
Mailing Address - Country:US
Mailing Address - Phone:270-442-7167
Mailing Address - Fax:270-442-7167
Practice Address - Street 1:275 WEDGEWOOD PLACE
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001
Practice Address - Country:US
Practice Address - Phone:270-442-7167
Practice Address - Fax:270-442-7167
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical