Provider Demographics
NPI:1417512302
Name:FARES, LINDA (FNP-C)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:FARES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3714 MERIWETHER DR APT H
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2876
Mailing Address - Country:US
Mailing Address - Phone:614-940-1491
Mailing Address - Fax:
Practice Address - Street 1:3714 MERIWETHER DR APT H
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2876
Practice Address - Country:US
Practice Address - Phone:614-940-1491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704353173363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner