Basic Information
Provider Information
NPI: 1003005182
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WALLS - MCCARTHA
FirstName: LINDA
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential: RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 592 ROCKAWAY AVE
Address2:  
City: BROOKLYN
State: NY
PostalCode: 112125539
CountryCode: US
TelephoneNumber: 7183455000
FaxNumber: 7189224239
Practice Location
Address1: 592 ROCKAWAY AVE
Address2:  
City: BROOKLYN
State: NY
PostalCode: 112125539
CountryCode: US
TelephoneNumber: 7183455000
FaxNumber: 7183455794
Other Information
ProviderEnumerationDate: 10/15/2007
LastUpdateDate: 05/19/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163WG0000X376995NYY Nursing Service ProvidersRegistered NurseGeneral Practice

No ID Information.


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