Provider Demographics
NPI:1699189613
Name:DUWA, LINDA (MSN, ACNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:DUWA
Suffix:
Gender:F
Credentials:MSN, ACNP
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 4105
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4105
Mailing Address - Country:US
Mailing Address - Phone:866-907-1060
Mailing Address - Fax:425-917-9141
Practice Address - Street 1:3200 PROVIDENCE DR
Practice Address - Street 2:SUITE B111
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4615
Practice Address - Country:US
Practice Address - Phone:907-212-7997
Practice Address - Fax:907-212-8225
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1397363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1619011Medicaid
AKK166827Medicare PIN