Provider Demographics
NPI:1952424921
Name:KORNER, LINDA T (LDR)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:T
Last Name:KORNER
Suffix:
Gender:F
Credentials:LDR
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:T
Other - Last Name:HAGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3831 66TH ST NE
Mailing Address - Street 2:
Mailing Address - City:RUGBY
Mailing Address - State:ND
Mailing Address - Zip Code:58368-7634
Mailing Address - Country:US
Mailing Address - Phone:701-776-5382
Mailing Address - Fax:
Practice Address - Street 1:800 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:RUGBY
Practice Address - State:ND
Practice Address - Zip Code:58368-2118
Practice Address - Country:US
Practice Address - Phone:701-776-5261
Practice Address - Fax:701-776-5448
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND264133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND12814OtherBLUE CROSS BLUE SHIELD
ND12814Medicare ID - Type Unspecified