Provider Demographics
NPI:1578296364
Name:KAHLHAMER, MINDY SUE (NP)
Entity Type:Individual
Prefix:MS
First Name:MINDY
Middle Name:SUE
Last Name:KAHLHAMER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 ROMBACH AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-1965
Mailing Address - Country:US
Mailing Address - Phone:937-366-1480
Mailing Address - Fax:
Practice Address - Street 1:1661 ROMBACH AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-1965
Practice Address - Country:US
Practice Address - Phone:937-366-1480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0031622363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily