Provider Demographics
NPI:1124286703
Name:ADAMS PETTERSSON, LINDA R (LVN)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:R
Last Name:ADAMS PETTERSSON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13358 JENNA CT
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-6339
Mailing Address - Country:US
Mailing Address - Phone:760-596-0775
Mailing Address - Fax:
Practice Address - Street 1:13358 JENNA CT
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-6339
Practice Address - Country:US
Practice Address - Phone:760-596-0775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA168858164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse