Provider Demographics
NPI:1114386224
Name:MAYO, LINDA (AGNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:MAYO
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 LA COSTA WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-8242
Mailing Address - Country:US
Mailing Address - Phone:978-870-8784
Mailing Address - Fax:
Practice Address - Street 1:609 HOGANS VALLEY WAY
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-5696
Practice Address - Country:US
Practice Address - Phone:919-522-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC197875363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology