Provider Demographics
NPI:1194844316
Name:WIEDE, LINDA M (WHCNP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:WIEDE
Suffix:
Gender:F
Credentials:WHCNP
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 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5201 HARRY HINES BLVD
Practice Address - Street 2:WISH TUBAL CLINIC
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7708
Practice Address - Country:US
Practice Address - Phone:214-266-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX235931363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX132799106Medicaid
TX132815504Medicaid
TX132815514Medicaid
TX132815515Medicaid
TX132815510Medicaid
TX132815513Medicaid
TX132815509Medicaid
TX132815512Medicaid
TX8Y1698OtherBLUE CROSS BLUE SHIELD
TX132815511Medicaid
TX132815516Medicaid