Basic Information
| Provider Information | |||||||||
| NPI: | 1730118720 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEADLE | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | JO | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 QUINCY ST | ||||||||
| Address2: | |||||||||
| City: | SHARON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020672246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817846229 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 COPELAND DR | ||||||||
| Address2: | |||||||||
| City: | MANSFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020481225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083394144 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 159221 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.