Provider Demographics
NPI:1750317913
Name:PUNCH, LINDA L (CNM)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:PUNCH
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1965 S FREMONT AVE STE 270
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2257
Mailing Address - Country:US
Mailing Address - Phone:417-820-3890
Mailing Address - Fax:
Practice Address - Street 1:1965 S FREMONT AVE STE 270
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2257
Practice Address - Country:US
Practice Address - Phone:417-820-3890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO063342367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
420001005OtherRR MEDICARE
OK100180610AMedicaid
KS100327140BMedicaid
MO254973803Medicaid
MO129622OtherANTHEM
KS100327140BMedicaid
S61586Medicare UPIN