MEDICARE: MS. LINDA DIANNE BROWN

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	LP18690	MD

General Provider Information

NPI Number	:	1912605171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LINDA DIANNE BROWN

Provider Business Mailing Address
First Line	:	51 N DUNDALK AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21222-4224
Country	:	US
Telephone Number	:	410-558-7163
Fax Number	:	410-522-6060

Provider Business Practice Location Address
First Line	:	51 N DUNDALK AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21222-4224
Country	:	US
Telephone Number	:	410-558-7163
Fax Number	:	410-522-6060

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

Provider Enumeration Date	:	02/17/2023
Last Update Date	:	02/17/2023

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