Provider Demographics
NPI:1609889732
Name:HORN, LINDA D (APRN)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:D
Last Name:HORN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 MAIN ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-6748
Mailing Address - Country:US
Mailing Address - Phone:207-784-0332
Mailing Address - Fax:
Practice Address - Street 1:460 MAIN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6748
Practice Address - Country:US
Practice Address - Phone:207-784-0332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER024440103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM5623Medicare ID - Type Unspecified