Provider Demographics
NPI:1497920029
Name:LINEBERRY, SUSAN P (NP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:P
Last Name:LINEBERRY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 N ELAM AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1150
Mailing Address - Country:US
Mailing Address - Phone:336-854-8800
Mailing Address - Fax:336-299-4308
Practice Address - Street 1:510 N ELAM AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1150
Practice Address - Country:US
Practice Address - Phone:336-854-8800
Practice Address - Fax:336-299-4308
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC800017363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner