Provider Demographics
NPI:1316496326
Name:LINVILLE, EDITH KATHLEEN (PMHNP)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:KATHLEEN
Last Name:LINVILLE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E JOPPA RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-3260
Mailing Address - Country:US
Mailing Address - Phone:410-337-0007
Mailing Address - Fax:
Practice Address - Street 1:1740 DANA ST
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-1409
Practice Address - Country:US
Practice Address - Phone:301-412-2394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR037226363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health