Provider Demographics
NPI:1730383787
Name:LAWS, LINDA
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:
Last Name:LAWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:LAWS-KUSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:3825 NE 202ND AVE
Mailing Address - Street 2:P.O. BOX 1322
Mailing Address - City:FAIRVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97024-7805
Mailing Address - Country:US
Mailing Address - Phone:503-318-0576
Mailing Address - Fax:503-667-2701
Practice Address - Street 1:3825 NE 202ND AVE
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:OR
Practice Address - Zip Code:97024-7805
Practice Address - Country:US
Practice Address - Phone:503-318-0576
Practice Address - Fax:503-667-2701
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR702952OtherMFCU PROVIDER NUMBER