MEDICARE: MRS. LIN MA NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	4704323745	MI
2	363LF0000X	Family Nurse Practitioner	4704323745	MI

General Provider Information

NPI Number	:	1073237608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LIN MA NP

Provider Business Mailing Address
First Line	:	65 EVALINE DR
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48085-4726
Country	:	US
Telephone Number	:	215-834-5982
Fax Number	:

Provider Business Practice Location Address
First Line	:	15120 MICHIGAN AVE
Second Line	:	SUITE A
City	:	DEARBORN
State	:	MI
Zip	:	48126-3768
Country	:	US
Telephone Number	:	313-843-8300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2022
Last Update Date	:	03/29/2023

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