Basic Information
| Provider Information | |||||||||
| NPI: | 1689804478 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BJORNSON | ||||||||
| FirstName: | LINDA | ||||||||
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| Credential: | GNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 877 OAK PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | PISMO BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934493292 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054748450 | ||||||||
| FaxNumber: | 8054748454 | ||||||||
| Practice Location | |||||||||
| Address1: | 877 OAK PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | PISMO BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934493292 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054748450 | ||||||||
| FaxNumber: | 8054748454 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2009 | ||||||||
| LastUpdateDate: | 03/05/2013 | ||||||||
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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 | 363L00000X | NP19057 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 364SG0600X | NP19057 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Gerontology |
ID Information
| ID | Type | State | Issuer | Description | NP19057 | 01 | CA | NP LICENSE | OTHER |