Provider Demographics
NPI:1679048342
Name:MODELFINO, LINDA ANNE (NP)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:ANNE
Last Name:MODELFINO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6301 BANSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-6572
Mailing Address - Country:US
Mailing Address - Phone:804-855-9520
Mailing Address - Fax:804-860-2026
Practice Address - Street 1:6301 BANSHIRE DR
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-6572
Practice Address - Country:US
Practice Address - Phone:804-855-9520
Practice Address - Fax:804-860-2026
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024176729363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA60155464Medicaid