Provider Demographics
NPI:1114391943
Name:KANDIE, LINET (CRNP)
Entity Type:Individual
Prefix:
First Name:LINET
Middle Name:
Last Name:KANDIE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9965 GUILFORD RD
Mailing Address - Street 2:
Mailing Address - City:JESSUP
Mailing Address - State:MD
Mailing Address - Zip Code:20794-3939
Mailing Address - Country:US
Mailing Address - Phone:240-413-1322
Mailing Address - Fax:
Practice Address - Street 1:3025 SOLOMONS ISLAND RD
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-1416
Practice Address - Country:US
Practice Address - Phone:410-798-8715
Practice Address - Fax:410-798-8730
Is Sole Proprietor?:No
Enumeration Date:2015-11-17
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR162580363LF0000X
DCRN1003737363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily