Provider Demographics
NPI:1790039329
Name:LINEBERRY, LEA (CRNP)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:
Last Name:LINEBERRY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 HOSPITAL DR STE 101
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-1927
Mailing Address - Country:US
Mailing Address - Phone:276-403-4733
Mailing Address - Fax:276-403-4734
Practice Address - Street 1:315 HOSPITAL DR STE 101
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112
Practice Address - Country:US
Practice Address - Phone:276-403-4733
Practice Address - Fax:276-403-4734
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC001098363LP0222X
VA0024170356363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care