Provider Demographics
NPI:1992871271
Name:PALMQUIST, LINDA (CRNP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:PALMQUIST
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:KSIAZEK PALMQUIST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3701 MARKET ST
Mailing Address - Street 2:6TH FLOOR SUITE 640
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3701 MARKET ST
Practice Address - Street 2:6TH FLOOR SUITE 640
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5502
Practice Address - Country:US
Practice Address - Phone:215-662-2250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP001148C363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA078593Medicare ID - Type Unspecified
Q14782Medicare UPIN