Healthcare Provider Details

I. General information

NPI: 1093842031
Provider Name (Legal Business Name): LINDA M HANEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 ALBRIGHT AVE #58
YELLOWSTONE NATIONAL PARK WY
82190
US

IV. Provider business mailing address

PO BOX 190930
BOISE ID
83719-0930
US

V. Phone/Fax

Practice location:
  • Phone: 307-344-7965
  • Fax:
Mailing address:
  • Phone: 208-367-5170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1471950
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10622A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: