Provider Demographics
NPI:1912327412
Name:MINO, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:MINO
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 1:400 W SEVENTH ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4506
Mailing Address - Country:US
Mailing Address - Phone:240-566-3653
Mailing Address - Fax:
Practice Address - Street 1:5500 BUCKEYSTOWN PIKE
Practice Address - Street 2:FMH WELLNESS
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-2870
Practice Address - Country:US
Practice Address - Phone:240-379-6045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR130386163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator