Provider Demographics
NPI:1548262769
Name:EARL, LINDA S (NP-C)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:S
Last Name:EARL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5844 S 920 E
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-1604
Mailing Address - Country:US
Mailing Address - Phone:801-451-3373
Mailing Address - Fax:801-451-3144
Practice Address - Street 1:50 E STATE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-2343
Practice Address - Country:US
Practice Address - Phone:801-451-3373
Practice Address - Fax:801-451-3144
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT208531-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT998877667000Medicaid