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General NPI Number Information
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NPI Number | 1063239903
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Entity Type | Individual
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Provider Name | LINDA NISANOVA
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Gender | Female
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Dates
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Enumeration Date | 09/23/2024
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Last Update Date | 09/23/2024
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Provider Practice Location Address
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Address Line | 166 DEFENSE HWY
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City | ANNAPOLIS
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State | MD
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Zip | 21401-8919
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Country | US
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Telephone | 410-684-3806
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Fax |
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Provider Business Mailing Address
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Address Line | 4901 SEMINARY RD APT 1403
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City | ALEXANDRIA
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State | VA
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Zip | 22311-1830
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Country | US
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Telephone | 917-536-3475
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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