1063819522 NPI number — MRS. DELORIS YVONNE LINTON LPN

Table of content: MRS. DELORIS YVONNE LINTON LPN (NPI 1063819522)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063819522 NPI number — MRS. DELORIS YVONNE LINTON LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LINTON
Provider First Name:
DELORIS
Provider Middle Name:
YVONNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LINTON
Provider Other First Name:
DELORIS
Provider Other Middle Name:
YVONNE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1063819522
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13 WIGGIN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEDHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02026-1600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-519-5744
Provider Business Mailing Address Fax Number:
781-326-3461

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13 WIGGIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEDHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02026-1600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-519-5744
Provider Business Practice Location Address Fax Number:
781-326-3461
Provider Enumeration Date:
11/28/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164W00000X , with the licence number:  LN92308 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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