MEDICARE: LINDA J RUNSTROM APNP

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	363LF0000X	Family Nurse Practitioner	R1513017	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558453068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA J RUNSTROM APNP

Provider Business Mailing Address
First Line	:	1836 SOUTH AVE
Second Line	:
City	:	LA CROSSE
State	:	WI
Zip	:	54601-5429
Country	:	US
Telephone Number	:	608-782-7300
Fax Number	:

Provider Business Practice Location Address
First Line	:	511 E MAPLE ST
Second Line	:
City	:	HOUSTON
State	:	MN
Zip	:	55943-9219
Country	:	US
Telephone Number	:	507-896-6000
Fax Number	:

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

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	04/28/2016

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