Healthcare Provider Details

I. General information

NPI: 1912995671
Provider Name (Legal Business Name): LINDA J WERNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDA JANET WERNER MD

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 10/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 E MARYDALE AVE STE 1
SOLDOTNA AK
99669
US

IV. Provider business mailing address

PO BOX 2949
SOLDOTNA AK
99669-2949
US

V. Phone/Fax

Practice location:
  • Phone: 907-262-3119
  • Fax: 907-262-9290
Mailing address:
  • Phone: 907-262-3119
  • Fax: 907-262-9290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301071662
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number29529-020
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number6597
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: