Provider Demographics
NPI:1811608771
Name:LINEBERRY, MARIAH TAREN (PA)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:TAREN
Last Name:LINEBERRY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14677 19C RD
Mailing Address - Street 2:
Mailing Address - City:ARGOS
Mailing Address - State:IN
Mailing Address - Zip Code:46501-9748
Mailing Address - Country:US
Mailing Address - Phone:574-767-6457
Mailing Address - Fax:
Practice Address - Street 1:770 W HIGH ST STE 160
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-5900
Practice Address - Country:US
Practice Address - Phone:419-996-4099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant