MEDICARE: LIA NELLA MAHLUM NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0200X	Pediatric Registered Nurse	318722	NC
2	363LF0000X	Family Nurse Practitioner	5022317	NC

General Provider Information

NPI Number	:	1659161826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIA NELLA MAHLUM NP

Provider Business Mailing Address
First Line	:	202 JEFFERSON ST
Second Line	:
City	:	SANFORD
State	:	NC
Zip	:	27330-5636
Country	:	US
Telephone Number	:	919-842-5190
Fax Number	:

Provider Business Practice Location Address
First Line	:	202 JEFFERSON ST
Second Line	:
City	:	SANFORD
State	:	NC
Zip	:	27330-5636
Country	:	US
Telephone Number	:	919-842-5190
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2025
Last Update Date	:	09/30/2025

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