Provider Demographics
NPI:1639158306
Name:NEISWENDER, LINDA L (DO)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:L
Last Name:NEISWENDER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:435-251-4100
Mailing Address - Fax:435-251-4101
Practice Address - Street 1:1380 E MEDICAL CENTER DR STE N1800
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-2123
Practice Address - Country:US
Practice Address - Phone:435-251-4100
Practice Address - Fax:435-251-4101
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12592848-1204207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02143201OtherCAPITAL BC / KEYSTONE
PA1519614OtherGATEWAY
PANE821359OtherPA BLUE SHIELD
PA157267401Medicaid
PA821359JBAMedicare ID - Type Unspecified
PANE821359OtherPA BLUE SHIELD