Provider Demographics
NPI:1235951849
Name:LANHOLM, KIMBERLY LYNN
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LYNN
Last Name:LANHOLM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 LIPPINCOTT DRIVE, SUITE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053
Mailing Address - Country:US
Mailing Address - Phone:856-355-0340
Mailing Address - Fax:
Practice Address - Street 1:6981 NORTH PARK DRIVE, SUITE 200A
Practice Address - Street 2:
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08109-4201
Practice Address - Country:US
Practice Address - Phone:856-663-4949
Practice Address - Fax:856-663-6076
Is Sole Proprietor?:No
Enumeration Date:2024-10-26
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15188000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily