Provider Demographics
NPI:1083357743
Name:LIN, ELISA BISI
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:BISI
Last Name:LIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4029 N HALL ST APT D
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-3622
Mailing Address - Country:US
Mailing Address - Phone:214-924-5501
Mailing Address - Fax:
Practice Address - Street 1:4029 N HALL ST APT D
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-3622
Practice Address - Country:US
Practice Address - Phone:214-924-5501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program