Provider Demographics
NPI:1720885064
Name:VASQUEZ, LINDA
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5631 MESSER RD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:MI
Mailing Address - Zip Code:49325-9731
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5631 MESSER RD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:MI
Practice Address - Zip Code:49325-9731
Practice Address - Country:US
Practice Address - Phone:616-291-7517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704302722163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse