Provider Demographics
NPI:1225044555
Name:WANNER, LINDA JEAN (NP)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:JEAN
Last Name:WANNER
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:284 EXECUTIVE PARK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1831
Mailing Address - Country:US
Mailing Address - Phone:704-939-1100
Mailing Address - Fax:704-939-1173
Practice Address - Street 1:1309 S CANNON BLVD
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-6232
Practice Address - Country:US
Practice Address - Phone:704-933-3212
Practice Address - Fax:704-933-3221
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC95008363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005033Medicaid
NC2806998AOtherMEDICARE
NC6005033Medicaid