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Individual

LINA NMN CLINE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
120 PARK EAST DR, ROSWELL, GA 30075-3011
(678) 523-4000
Mailing address
120 PARK EAST DR, ROSWELL, GA 30075-3011
(678) 523-4000

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN139141
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
791785509B
GA
Enumeration date
05/10/2006
Last updated
04/15/2015
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