Provider Demographics
NPI:1689665150
Name:MICHAEL, LINDA A (ARNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:A
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3370 WYLIE DR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-8804
Mailing Address - Country:US
Mailing Address - Phone:509-741-9731
Mailing Address - Fax:
Practice Address - Street 1:3370 WYLIE DR
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-8804
Practice Address - Country:US
Practice Address - Phone:509-741-9731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006061207Q00000X
WARN00037722207Q00000X
MTRN101569207Q00000X
MTNURAPRNLIC101792363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9631847Medicaid
WA9631847Medicaid