Healthcare Provider Details

I. General information

NPI: 1649434499
Provider Name (Legal Business Name): MARY MORSE LINN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8503 ARLINGTON BLVD SUITE 310
FAIRFAX VA
22031-4628
US

IV. Provider business mailing address

10301 DEMOCRACY LN #410 NORTHERN VIRGINIA UROLOGY PLLC
FAIRFAX VA
22031
US

V. Phone/Fax

Practice location:
  • Phone: 703-208-4200
  • Fax: 703-876-1799
Mailing address:
  • Phone: 703-876-5942
  • Fax: 703-876-5972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024167897
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: