Provider Demographics
NPI:1497324107
Name:LIN, ANNIE (CNS)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:
Last Name:LIN
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6161 NW 2ND AVE APT 214
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-3047
Mailing Address - Country:US
Mailing Address - Phone:817-542-6323
Mailing Address - Fax:
Practice Address - Street 1:6161 NW 2ND AVE APT 214
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-3047
Practice Address - Country:US
Practice Address - Phone:817-542-6323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education