Basic Information
| Provider Information | |||||||||
| NPI: | 1912995671 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WERNER | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WERNER | ||||||||
| OtherFirstName: | LINDA | ||||||||
| OtherMiddleName: | JANET | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 2949 | ||||||||
| Address2: | |||||||||
| City: | SOLDOTNA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996692949 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9072623119 | ||||||||
| FaxNumber: | 9072629290 | ||||||||
| Practice Location | |||||||||
| Address1: | 230 E MARYDALE AVE STE 1 | ||||||||
| Address2: | |||||||||
| City: | SOLDOTNA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9072623119 | ||||||||
| FaxNumber: | 9072629290 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2005 | ||||||||
| LastUpdateDate: | 10/15/2018 | ||||||||
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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 | 207R00000X | 4301071662 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 29529-020 | WI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 6597 | AK | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | K164556 | 01 | AK | MEDICARE PTAN | OTHER | 389588041 | 01 | CA | TRICARE | OTHER | MD9296 | 05 | AK | MEDICAID | P00168644 | 01 | WI | RR-MEDICARE | OTHER | 31530100 | 05 | WI | MEDICAID | K0000WCVBS | 01 | AK | MEDICARE PRACTICE PTAN PENINSULA INTERNAL MEDICINE | OTHER | 389588041900 | 01 | WI | BCBS | OTHER |