Provider Demographics
NPI:1588833750
Name:CAPDEBOSCQ, LINDA A (NP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:A
Last Name:CAPDEBOSCQ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1643 HIGHWAY 55
Mailing Address - Street 2:
Mailing Address - City:MONTEGUT
Mailing Address - State:LA
Mailing Address - Zip Code:70377-3214
Mailing Address - Country:US
Mailing Address - Phone:509-710-7119
Mailing Address - Fax:
Practice Address - Street 1:140 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:TUBA CITY
Practice Address - State:AZ
Practice Address - Zip Code:86045
Practice Address - Country:US
Practice Address - Phone:928-283-2402
Practice Address - Fax:208-746-6348
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09958363L00000X
IDNP-1419A363L00000X
WAAP30007916363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1054955OtherPROVIDER ONE
ID324005OtherL & I (NON NETWORK)
WA1054955OtherPROVIDER ONE
WAGAB8927774Medicare PIN