Provider Demographics
NPI:1053905059
Name:KINSALL, ELIZABETH RENEE LYNN
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:RENEE LYNN
Last Name:KINSALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 WELSH HILL RD
Mailing Address - Street 2:
Mailing Address - City:FROSTBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21532-2332
Mailing Address - Country:US
Mailing Address - Phone:240-727-2241
Mailing Address - Fax:
Practice Address - Street 1:46 WOOD CHUCK LN
Practice Address - Street 2:
Practice Address - City:FORT ASHBY
Practice Address - State:WV
Practice Address - Zip Code:26719-6940
Practice Address - Country:US
Practice Address - Phone:240-727-5333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker