Basic Information
| Provider Information | |||||||||
| NPI: | 1518203017 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LINDHOLM | ||||||||
| FirstName: | MOLLIE | ||||||||
| MiddleName: | O'MARA | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4734 LONG BEACH RD SE | ||||||||
| Address2: | |||||||||
| City: | SOUTHPORT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284618721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104570070 | ||||||||
| FaxNumber: | 9104570062 | ||||||||
| Practice Location | |||||||||
| Address1: | 4734 LONG BEACH RD SE | ||||||||
| Address2: | |||||||||
| City: | SOUTHPORT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284618721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104570070 | ||||||||
| FaxNumber: | 9104570062 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2013 | ||||||||
| LastUpdateDate: | 01/02/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 0010-03947 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 0010-03947 | 01 | NC | PHYSICAIN ASSISTANT | OTHER |