Provider Demographics
NPI:1013791334
Name:MULLHOLAND, AMY SUE (HEALTH COACH)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:SUE
Last Name:MULLHOLAND
Suffix:
Gender:F
Credentials:HEALTH COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2654 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FOSTORIA
Mailing Address - State:OH
Mailing Address - Zip Code:44830-1303
Mailing Address - Country:US
Mailing Address - Phone:567-737-0683
Mailing Address - Fax:
Practice Address - Street 1:2654 BROOKSIDE DR
Practice Address - Street 2:
Practice Address - City:FOSTORIA
Practice Address - State:OH
Practice Address - Zip Code:44830-1303
Practice Address - Country:US
Practice Address - Phone:567-737-0683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach