Provider Demographics
NPI:1437510765
Name:MCINTYRE, LINDA
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 E CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735-2233
Mailing Address - Country:US
Mailing Address - Phone:660-351-0995
Mailing Address - Fax:
Practice Address - Street 1:2846 WILLAMETTE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-8200
Practice Address - Country:US
Practice Address - Phone:541-222-8700
Practice Address - Fax:541-222-8701
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-14
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201602597NP-PP363L00000X
MO2016007859363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner