Provider Demographics
NPI:1841222304
Name:VONWEDELL, LINDA L (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:L
Last Name:VONWEDELL
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:PO BOX 2546
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-2546
Mailing Address - Country:US
Mailing Address - Phone:620-783-4441
Mailing Address - Fax:620-783-4090
Practice Address - Street 1:444 FOUR STATES DR
Practice Address - Street 2:STE 1
Practice Address - City:GALENA
Practice Address - State:KS
Practice Address - Zip Code:66379-4325
Practice Address - Country:US
Practice Address - Phone:620-783-4441
Practice Address - Fax:620-783-4090
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0056505363L00000X
MO108189363L00000X
KS53-45803-072363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKR0056505OtherOKLAHOMA ARNP LICENSE
MO710894993OtherTAX ID
OKR0056505OtherOKLAHOMA ARNP LICENSE
KS130543Medicare PIN
MO710894993OtherTAX ID
P00287333Medicare PIN