Active NPI
Linda Ann Mannino, APRN BC MSN CNP
- Nurse Practitioner
- Roseville, MI
National Provider Identifier
1073520052
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 4704148987
- Practice address
- 25195 Kelly Rd
Suite a
Roseville, MI 48066-4909 - Phone
- (586) 775-4594
- Fax
- (586) 775-4506
- NPI assigned
- Aug 2, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 4704148987 | MI | Primary |
Addresses
Primary practice location
25195 Kelly Rd
Suite a
Roseville, MI 48066-4909
Mailing address
25195 Kelly Rd
Suite a
Roseville, MI 48066-4909
Phone (586) 775-4594
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500 866 4760 | Other | MI | BCBS |
| 496016910 | Medicaid | MI | |
| OH-26467022 | Other | MI | MEDICARE ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Practitioner, Master of Science - Nursing, Nurse Practitioner
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1359676800000",
"number": "1073520052",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25195 KELLY RD",
"address_2": "SUITE A",
"city": "ROSEVILLE",
"state": "MI",
"postal_code": "480664909",
"telephone_number": "586-775-4594",
"fax_number": "586-775-4506"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25195 KELLY RD",
"address_2": "SUITE A",
"city": "ROSEVILLE",
"state": "MI",
"postal_code": "480664909",
"telephone_number": "586-775-4594",
"fax_number": "586-775-4506"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANNINO",
"first_name": "LINDA",
"middle_name": "ANN",
"credential": "APRN BC MSN CNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-02",
"last_updated": "2013-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MI",
"license": "4704148987",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "500 866 4760",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "496016910",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE ID",
"identifier": "OH-26467022",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Roseville, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.