Provider Demographics
NPI:1174938575
Name:HOMMES, LINDA LEE (APRN, CNS)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:LEE
Last Name:HOMMES
Suffix:
Gender:F
Credentials:APRN, CNS
Other - Prefix:MISS
Other - First Name:LINDA
Other - Middle Name:LEE
Other - Last Name:BRYCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, CNS
Mailing Address - Street 1:12251 S 80TH AVE STE 1520
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1290
Mailing Address - Country:US
Mailing Address - Phone:708-923-4200
Mailing Address - Fax:708-923-4201
Practice Address - Street 1:12251 S 80TH AVE STE 1520
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1290
Practice Address - Country:US
Practice Address - Phone:708-923-4200
Practice Address - Fax:708-923-4201
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277000397364SA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400294095OtherMEDICARE PTAN