Healthcare Provider Details

I. General information

NPI: 1427128115
Provider Name (Legal Business Name): LINDA L TIMM RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDA LINNEKIN

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 02/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6829 ELM ST SUITE 300
MC LEAN VA
22101-3884
US

IV. Provider business mailing address

6829 ELM ST
MC LEAN VA
22101-3884
US

V. Phone/Fax

Practice location:
  • Phone: 703-532-4892
  • Fax:
Mailing address:
  • Phone: 703-532-4892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: