Provider Demographics
NPI:1558377010
Name:CARMICHAEL, LINDA L (FNP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:CARMICHAEL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6023 SE STEPHENS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-3458
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CALDERA WELLNESS
Practice Address - Street 2:6023 SE STEPHENS STREET
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-3458
Practice Address - Country:US
Practice Address - Phone:541-510-8741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR083039667N1363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR041967Medicaid
S35650Medicare UPIN