Provider Demographics
NPI:1093922486
Name:ELSASSER, LIN MARY
Entity Type:Individual
Prefix:
First Name:LIN
Middle Name:MARY
Last Name:ELSASSER
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 1:412 WILLOW CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-4810
Mailing Address - Country:US
Mailing Address - Phone:559-306-2410
Mailing Address - Fax:
Practice Address - Street 1:412 WILLOW CREEK DR
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-4810
Practice Address - Country:US
Practice Address - Phone:559-306-2410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT30002471S1302X
TX30092471S1302X
CARHM895562471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography