Provider Demographics
NPI:1659161826
Name:MAHLUM, LIA NELLA (NP)
Entity type:Individual
Prefix:
First Name:LIA
Middle Name:NELLA
Last Name:MAHLUM
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 1:202 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-5636
Mailing Address - Country:US
Mailing Address - Phone:919-842-5190
Mailing Address - Fax:
Practice Address - Street 1:202 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-5636
Practice Address - Country:US
Practice Address - Phone:919-842-5190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-09
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC318722163WP0200X
NC5022317363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP0200XNursing Service ProvidersRegistered NursePediatrics