MEDICARE: LINDA HORSTMANN LBSW MED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator		AK

General Provider Information

NPI Number	:	1457528887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA HORSTMANN LBSW MED

Provider Business Mailing Address
First Line	:	HC 89 BOX 560H
Second Line	:
City	:	WILLOW
State	:	AK
Zip	:	99688-9707
Country	:	US
Telephone Number	:	907-733-3368
Fax Number	:

Provider Business Practice Location Address
First Line	:	17040 EAST MONTANA CREEK ROAD
Second Line	:
City	:	WILLOW
State	:	AK
Zip	:	99688-9707
Country	:	US
Telephone Number	:	907-733-3368
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2008
Last Update Date	:	05/30/2008

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