Provider Demographics
NPI:1427073295
Name:PIEROG, LINDA JEAN (NP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:JEAN
Last Name:PIEROG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:J
Other - Last Name:PIEROG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 690
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90801-0690
Mailing Address - Country:US
Mailing Address - Phone:562-809-3547
Mailing Address - Fax:
Practice Address - Street 1:1100 WEST STEWART DRIVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3849
Practice Address - Country:US
Practice Address - Phone:714-633-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN233694363L00000X
CA15589363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN233694Medicaid
CARN233694Medicaid
CADD900ZMedicare PIN
CAWNP15589AMedicare PIN