MEDICARE: LINDA NGAMEDURU

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	363LF0000X	Family Nurse Practitioner	R158706	MD

General Provider Information

NPI Number	:	1346637394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA NGAMEDURU

Provider Business Mailing Address
First Line	:	11917 REISTERSTOWN RD
Second Line	:
City	:	REISTERSTOWN
State	:	MD
Zip	:	21136-3030
Country	:	US
Telephone Number	:	410-833-0183
Fax Number	:

Provider Business Practice Location Address
First Line	:	11917 REISTERSTOWN RD
Second Line	:
City	:	REISTERSTOWN
State	:	MD
Zip	:	21136-3030
Country	:	US
Telephone Number	:	410-833-0183
Fax Number	:

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

Provider Enumeration Date	:	04/16/2015
Last Update Date	:	04/16/2015

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Directions to “ LINDA NGAMEDURU ” Practice Location

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