Provider Demographics
NPI:1790462414
Name:XU, LIN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:LIN
Middle Name:
Last Name:XU
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:
Other - Last Name:XU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:275 LAKE VILLAGE DR APT 103
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6542
Mailing Address - Country:US
Mailing Address - Phone:206-384-6948
Mailing Address - Fax:
Practice Address - Street 1:306 W WASHINGTON AVE STE 102
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2141
Practice Address - Country:US
Practice Address - Phone:517-435-0260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-04
Last Update Date:2023-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704363404363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner