Provider Demographics
NPI:1245453604
Name:MASTRO, LINDA JANE (CRNP)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:JANE
Last Name:MASTRO
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:PO BOX 287
Mailing Address - Street 2:
Mailing Address - City:PORTAGE LAKE
Mailing Address - State:ME
Mailing Address - Zip Code:04768-0287
Mailing Address - Country:US
Mailing Address - Phone:207-435-2850
Mailing Address - Fax:207-760-1159
Practice Address - Street 1:33 EDGEMONT DR
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-2016
Practice Address - Country:US
Practice Address - Phone:207-768-2803
Practice Address - Fax:207-760-1159
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME031908363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner