Provider Demographics
NPI:1104473255
Name:HOWARD, LINZIE A
Entity type:Individual
Prefix:
First Name:LINZIE
Middle Name:A
Last Name:HOWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46808-1328
Mailing Address - Country:US
Mailing Address - Phone:260-739-5821
Mailing Address - Fax:260-527-4802
Practice Address - Street 1:3010 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46808-1328
Practice Address - Country:US
Practice Address - Phone:260-739-5821
Practice Address - Fax:260-527-4802
Is Sole Proprietor?:No
Enumeration Date:2019-08-23
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71009277A363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care