Provider Demographics
NPI:1275596611
Name:LINENBERGER, ANNE (PAC)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:LINENBERGER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:HENDEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:1514 K 96 HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530
Mailing Address - Country:US
Mailing Address - Phone:620-792-4383
Mailing Address - Fax:620-792-2058
Practice Address - Street 1:1514 K 96 HIGHWAY
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530
Practice Address - Country:US
Practice Address - Phone:620-792-4383
Practice Address - Fax:620-792-2058
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1500402363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00079419OtherRR MC
4036OtherPREFERRED HEALTH
R32066Medicare UPIN
P00079419OtherRR MC