Healthcare Provider Details

I. General information

NPI: 1649665357
Provider Name (Legal Business Name): MIRIAM D LINTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MIRIAM D LINTON BSN, RN

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 03/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 WILDWOOD CIR
HOLTSVILLE NY
11742-1617
US

IV. Provider business mailing address

146 WILDWOOD CIR
HOLTSVILLE NY
11742-1617
US

V. Phone/Fax

Practice location:
  • Phone: 631-901-1111
  • Fax:
Mailing address:
  • Phone: 631-901-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number621662-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: