Provider Demographics
NPI:1295957736
Name:WELLS-FREIBERGER, LINDA CAROL (NP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:CAROL
Last Name:WELLS-FREIBERGER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 NORTH STATE ROAD 135
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IN
Mailing Address - Zip Code:47167
Mailing Address - Country:US
Mailing Address - Phone:812-883-8164
Mailing Address - Fax:
Practice Address - Street 1:202 CHERRY STREET
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:IN
Practice Address - Zip Code:47454
Practice Address - Country:US
Practice Address - Phone:812-723-0150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000471A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
INTB0970Medicare ID - Type Unspecified
INS62780Medicare UPIN