Provider Demographics
NPI:1457474462
Name:LINDHOLM, ERIC MARK (CFA)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:MARK
Last Name:LINDHOLM
Suffix:
Gender:M
Credentials:CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6767 WEST 29TH STREET
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-1141
Mailing Address - Country:US
Mailing Address - Phone:970-652-2426
Mailing Address - Fax:
Practice Address - Street 1:6767 W 29TH STREET
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-5474
Practice Address - Country:US
Practice Address - Phone:970-652-2426
Practice Address - Fax:970-652-2478
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
COSA.0001465246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical