Provider Demographics
NPI:1992967186
Name:PIACENTINE, LINDA B (NP)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:B
Last Name:PIACENTINE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:L
Other - Last Name:BENTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10000 W INNOVATION DR
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4837
Mailing Address - Country:US
Mailing Address - Phone:414-456-5006
Mailing Address - Fax:414-456-6259
Practice Address - Street 1:1155 N MAYFAIR RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3421
Practice Address - Country:US
Practice Address - Phone:414-805-3666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-28
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI108656363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1992967186Medicaid