Healthcare Provider Details

I. General information

NPI: 1821836735
Provider Name (Legal Business Name): LINDA G WIDENER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 NW STEWART PKWY STE 102
ROSEBURG OR
97471-1670
US

IV. Provider business mailing address

6700 WASHINGTON AVE S
EDEN PRAIRIE MN
55344-3405
US

V. Phone/Fax

Practice location:
  • Phone: 800-328-8602
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHAS-P-10244628
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: