1063849131 NPI number — CAROL ANN HOLMDEN NP

Table of content: CAROL ANN HOLMDEN NP (NPI 1063849131)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063849131 NPI number — CAROL ANN HOLMDEN NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLMDEN
Provider First Name:
CAROL
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063849131
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5022 RIFLE RIVER TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALGER
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48610-9327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-873-1571
Provider Business Mailing Address Fax Number:
989-873-1574

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
81 S I 75 BUSINESS LOOP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAYLING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49738-7405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-348-7400
Provider Business Practice Location Address Fax Number:
888-821-5005
Provider Enumeration Date:
10/03/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  4704147309 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)