Basic Information
| Provider Information | |||||||||
| NPI: | 1609946243 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LINMAN | ||||||||
| FirstName: | SINA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3135 W BROADWAY | ||||||||
| Address2: | |||||||||
| City: | COUNCIL BLUFFS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 515013359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7123289100 | ||||||||
| FaxNumber: | 4023280095 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 EDMUNDSON PL | ||||||||
| Address2: | |||||||||
| City: | COUNCIL BLUFFS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 51503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7123964310 | ||||||||
| FaxNumber: | 7123964180 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2006 | ||||||||
| LastUpdateDate: | 06/18/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 052795 | IA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1609946243 | 05 | NE | MEDICAID |