Provider Demographics
NPI:1093842031
Name:HANEY, LINDA M (MD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:M
Last Name:HANEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 ALBRIGHT AVE
Mailing Address - Street 2:#58
Mailing Address - City:YELLOWSTONE NAITONAL PARK
Mailing Address - State:WY
Mailing Address - Zip Code:82190
Mailing Address - Country:US
Mailing Address - Phone:307-344-7965
Mailing Address - Fax:
Practice Address - Street 1:108 ALBRIGHT AVE
Practice Address - Street 2:#58
Practice Address - City:YELLOWSTONE NATIONAL PARK
Practice Address - State:WY
Practice Address - Zip Code:82190
Practice Address - Country:US
Practice Address - Phone:307-344-7965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY10622A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC484188Medicare PIN
COF96420Medicare UPIN
COF96420Medicare UPIN
COC484188Medicare PIN