Provider Demographics
NPI:1124272703
Name:EDDY, LINDA LEE (PNP, RN)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:LEE
Last Name:EDDY
Suffix:
Gender:F
Credentials:PNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1001
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-8001
Mailing Address - Country:US
Mailing Address - Phone:503-366-4005
Mailing Address - Fax:503-366-0314
Practice Address - Street 1:1621 COLUMBIA BLVD
Practice Address - Street 2:
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-6221
Practice Address - Country:US
Practice Address - Phone:503-366-4005
Practice Address - Fax:503-366-0314
Is Sole Proprietor?:No
Enumeration Date:2008-11-10
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR078040320N2363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics