Provider Demographics
NPI:1306915087
Name:MORELAND, LINDA RAE (MSN, APRN, BC)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:RAE
Last Name:MORELAND
Suffix:
Gender:F
Credentials:MSN, APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 PENNOCK TER
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-2316
Mailing Address - Country:US
Mailing Address - Phone:610-394-6465
Mailing Address - Fax:610-394-6695
Practice Address - Street 1:3 PENNOCK TER
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:PA
Practice Address - Zip Code:19050-2316
Practice Address - Country:US
Practice Address - Phone:610-394-6465
Practice Address - Fax:610-394-6695
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN197543L364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
0007873001OtherAETNA
2318681000OtherKEYSTONE HEALTH PLAN EAST
2318681000OtherPERSONAL CHOICE
MO603266OtherBLUE CROSSBLUE SHIELD
2318681000OtherPERSONAL CHOICE