Basic Information
| Provider Information | |||||||||
| NPI: | 1073612750 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LINDENMUTH | ||||||||
| FirstName: | MARILYN | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22 AVIS MILL RD | ||||||||
| Address2: | |||||||||
| City: | PILESGROVE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080983001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567692157 | ||||||||
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| Practice Location | |||||||||
| Address1: | 711 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | GLASSBORO | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080281639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568819531 | ||||||||
| FaxNumber: | 8568632816 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 10/04/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 26N004968600 | NJ | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LW0102X | 26N004968600 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.