Provider Demographics
NPI:1841586526
Name:QIN-NELSON, LING (DO)
Entity type:Individual
Prefix:
First Name:LING
Middle Name:
Last Name:QIN-NELSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 W BERRY ST
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802-2106
Mailing Address - Country:US
Mailing Address - Phone:260-423-1331
Mailing Address - Fax:260-422-1046
Practice Address - Street 1:604 W BERRY ST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-2106
Practice Address - Country:US
Practice Address - Phone:260-423-1331
Practice Address - Fax:260-422-1046
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101019531207R00000X
IN02005348A207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology