Provider Demographics
NPI:1396859690
Name:LAU, LINDA G (ANP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:G
Last Name:LAU
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2835 FORT MISSOULA RD
Mailing Address - Street 2:BUILDING 3, SUITE 301
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-7423
Mailing Address - Country:US
Mailing Address - Phone:406-327-4279
Mailing Address - Fax:
Practice Address - Street 1:2835 FORT MISSOULA RD
Practice Address - Street 2:BUILDING 3, SUITE 301
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7423
Practice Address - Country:US
Practice Address - Phone:406-327-4279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK868363LP0200X
MTNUR-RN-LIC-68162363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP0867Medicaid