Provider Demographics
NPI:1689603839
Name:OPSAHL, LINDA M (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:M
Last Name:OPSAHL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 EAST BLVD
Mailing Address - Street 2:
Mailing Address - City:KINGSFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49802-4436
Mailing Address - Country:US
Mailing Address - Phone:906-774-4000
Mailing Address - Fax:906-774-0088
Practice Address - Street 1:800 EAST BLVD
Practice Address - Street 2:
Practice Address - City:KINGSFORD
Practice Address - State:MI
Practice Address - Zip Code:49802
Practice Address - Country:US
Practice Address - Phone:906-774-4000
Practice Address - Fax:906-774-0088
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704113267363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1026368OtherPREFERRED ONE
MI500024567OtherRR MEDICARE
MI4223499Medicaid
MI5008764350OtherBCBS MI
MI4223505Medicaid
WI43923100Medicaid
MI4441667Medicaid
MI1026368OtherPREFERRED ONE
MI4223499Medicaid