Basic Information
| Provider Information | |||||||||
| NPI: | 1750317913 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PUNCH | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1965 S FREMONT AVE STE 270 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658042257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178203890 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1965 S FREMONT AVE STE 270 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658042257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178203890 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2006 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 063342 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 420001005 | 01 | RR MEDICARE | OTHER | 100180610A | 05 | OK | MEDICAID | 100327140B | 05 | KS | MEDICAID | 254973803 | 05 | MO | MEDICAID | 129622 | 01 | MO | ANTHEM | OTHER |