Provider Demographics
NPI:1821014630
Name:LINDHOLM, LESLIE ANN (RN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:ANN
Last Name:LINDHOLM
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:948 JUSTICE RD
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:TX
Mailing Address - Zip Code:78963-5232
Mailing Address - Country:US
Mailing Address - Phone:832-289-5060
Mailing Address - Fax:
Practice Address - Street 1:750 W TRAVIS ST
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:TX
Practice Address - Zip Code:78945-2522
Practice Address - Country:US
Practice Address - Phone:979-968-3711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX666287363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ36813Medicare UPIN
TX8D2815Medicare ID - Type Unspecified