MEDICARE: MS. MARCIA SUSAN LINN LPN

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	164W00000X	Licensed Practical Nurse	PN137443	OH

General Provider Information

NPI Number	:	1760796056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARCIA SUSAN LINN LPN

Provider Business Mailing Address
First Line	:	6314 BUSCH BLVD
Second Line	:	APT. #185
City	:	COLUMBUS
State	:	OH
Zip	:	43229-1809
Country	:	US
Telephone Number	:	678-485-6200
Fax Number	:

Provider Business Practice Location Address
First Line	:	6314 BUSCH BLVD
Second Line	:	APT. #185
City	:	COLUMBUS
State	:	OH
Zip	:	43229-1809
Country	:	US
Telephone Number	:	678-485-6200
Fax Number	:

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

Provider Enumeration Date	:	07/29/2010
Last Update Date	:	07/29/2010

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