Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | SP023051 | PA |
N | 363LW0102X | Nurse Practitioner - Women's Health | SP023051 | PA |
NPI | 1093303745 |
---|---|
Provider Name | Mia Geneva Lin |
First Address | Danville, PA 17822-4903 |
Second Address | Wilkes Barre, PA 18702-7906 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2021 |
Last Update Date | 08/03/2021 |