Healthcare Provider Details

I. General information

NPI: 1093303745
Provider Name (Legal Business Name): MIA GENEVA LIN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S WASHINGTON AVE
SCRANTON PA
18505-1639
US

IV. Provider business mailing address

820 S WASHINGTON AVE
SCRANTON PA
18505-1639
US

V. Phone/Fax

Practice location:
  • Phone: 570-595-4496
  • Fax: 570-955-0139
Mailing address:
  • Phone: 570-595-4496
  • Fax: 570-955-0139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP023051
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberSP023051
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: