Provider Demographics
NPI:1467175349
Name:LIN, POLLY (NP)
Entity Type:Individual
Prefix:
First Name:POLLY
Middle Name:
Last Name:LIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 W COLORADO ST STE 205
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-3640
Mailing Address - Country:US
Mailing Address - Phone:323-794-1363
Mailing Address - Fax:323-488-9782
Practice Address - Street 1:15211 VANOWEN ST STE 300
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3617
Practice Address - Country:US
Practice Address - Phone:818-782-4104
Practice Address - Fax:818-475-1823
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95021100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily