Provider Demographics
NPI:1073612750
Name:LINDENMUTH, MARILYN J (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:J
Last Name:LINDENMUTH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 AVIS MILL RD
Mailing Address - Street 2:
Mailing Address - City:PILESGROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:08098-3001
Mailing Address - Country:US
Mailing Address - Phone:856-769-2157
Mailing Address - Fax:
Practice Address - Street 1:711 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028-1639
Practice Address - Country:US
Practice Address - Phone:856-881-9531
Practice Address - Fax:856-863-2816
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26N004968600363L00000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner