Provider Demographics
NPI:1972271674
Name:LINDHOLM, CHARITY ANN (RN)
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:ANN
Last Name:LINDHOLM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 691
Mailing Address - Street 2:
Mailing Address - City:SUNDANCE
Mailing Address - State:WY
Mailing Address - Zip Code:82729-0691
Mailing Address - Country:US
Mailing Address - Phone:307-282-0976
Mailing Address - Fax:
Practice Address - Street 1:26 WINDY WAY
Practice Address - Street 2:
Practice Address - City:SUNDANCE
Practice Address - State:WY
Practice Address - Zip Code:82729-5236
Practice Address - Country:US
Practice Address - Phone:307-468-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY32380163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse