# LINDA ANN MANNINO

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1073520052
- **Gender:** F
- **Credential:** APRN BC MSN CNP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | 4704148987 | MI | Yes |

## Other

- **Enumeration date:** 08/02/2006
- **Last updated:** 02/01/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 496016910 | — | MI |
| 01 | — | 500 866 4760 | BCBS | MI |
| 01 | — | OH-26467022 | MEDICARE ID | MI |