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Individual

LINDA M WIEDE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
WHCNP

Contact information

Practice address
5201 HARRY HINES BLVD, WISH TUBAL CLINIC, DALLAS, TX 75235-7708
(214) 266-0900
Mailing address
PO BOX 660599, DALLAS, TX 75266-0599

Taxonomy

Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
235931
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
132799106
TX
05
132815504
TX
05
132815509
TX
05
132815510
TX
05
132815511
TX
05
132815512
TX
05
132815513
TX
05
132815514
TX
05
132815515
TX
05
132815516
TX
01
8Y1698
BLUE CROSS BLUE SHIELD
TX
Enumeration date
03/28/2007
Last updated
04/13/2009
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