Provider Demographics
NPI:1942241765
Name:EGWIM, LINDA A (ANP, GNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:A
Last Name:EGWIM
Suffix:
Gender:F
Credentials:ANP, GNP
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:A
Other - Last Name:NDUBIZU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP, GNP
Mailing Address - Street 1:701 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1623
Mailing Address - Country:US
Mailing Address - Phone:612-873-6005
Mailing Address - Fax:612-630-8242
Practice Address - Street 1:701 PARK AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1623
Practice Address - Country:US
Practice Address - Phone:612-873-2720
Practice Address - Fax:612-904-4243
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2022-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN355725-21363LA2200X
MN352079-23363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN04-03064OtherMEDICA
MN45D97NDOtherBLUE CROSS BLUE SHIELD
MNP00069038OtherMEDICARE RAILROAD
MNP20400Medicare UPIN