Provider Demographics
NPI:1194709147
Name:MARDEN, LINDA A (MD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:A
Last Name:MARDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 S 16TH ST
Mailing Address - Street 2:STE 400A
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-3785
Mailing Address - Country:US
Mailing Address - Phone:402-483-8590
Mailing Address - Fax:402-483-8575
Practice Address - Street 1:2400 S AVENUE A
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7127
Practice Address - Country:US
Practice Address - Phone:928-344-2000
Practice Address - Fax:928-336-7520
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN447622084N0400X
AL307592084N0400X
NE301712084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL136015Medicaid
AZZ169127Medicare PIN
AL136015Medicaid