Healthcare Provider Details

I. General information

NPI: 1841225364
Provider Name (Legal Business Name): NADINE MARIE LINENDOLL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE BRAIN TUMOR CENTER
BOSTON MA
02215-5400
US

IV. Provider business mailing address

1160 COMMONWEALTH AVE APT 25
ALLSTON MA
02134-4715
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-1665
  • Fax:
Mailing address:
  • Phone: 617-566-2352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number240758
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: