Provider Demographics
NPI:1699777508
Name:DASHIELL, LINDA ANNA (RN CNM)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:ANNA
Last Name:DASHIELL
Suffix:
Gender:F
Credentials:RN CNM
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:ANNA
Other - Last Name:WILLITS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:9600 WEST RD
Mailing Address - Street 2:
Mailing Address - City:POTTER VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95469-8705
Mailing Address - Country:US
Mailing Address - Phone:707-743-1538
Mailing Address - Fax:
Practice Address - Street 1:230 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4563
Practice Address - Country:US
Practice Address - Phone:707-462-5025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN421257163W00000X
CANMW 1661367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse