MEDICARE: MRS. LEAH MICHELLE LIN WHNP

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	081476	CT
2	363LW0102X	Women's Health Nurse Practitioner	741506 OR 18750	CA
3	390200000X	Student in an Organized Health Care Education/Training Program
4	363LW0102X	Women's Health Nurse Practitioner	822113	NV

General Provider Information

NPI Number	:	1871763177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LEAH MICHELLE LIN WHNP

Provider Business Mailing Address
First Line	:	701 SAN MATEO BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87108-1434
Country	:	US
Telephone Number	:	505-265-9511
Fax Number	:	505-814-5743

Provider Business Practice Location Address
First Line	:	3220 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1932
Country	:	US
Telephone Number	:	702-878-7776
Fax Number	:	707-878-7078

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

Provider Enumeration Date	:	03/03/2008
Last Update Date	:	10/21/2021

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