Provider Demographics
NPI:1619424256
Name:PELOSO, LINZY (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:LINZY
Middle Name:
Last Name:PELOSO
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 IRONWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-8408
Mailing Address - Country:US
Mailing Address - Phone:401-206-1572
Mailing Address - Fax:
Practice Address - Street 1:925 MAIN STREET
Practice Address - Street 2:#100
Practice Address - City:PENNSBURG
Practice Address - State:PA
Practice Address - Zip Code:18073
Practice Address - Country:US
Practice Address - Phone:215-541-1333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013764363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics