1356536924 NPI number — MRS. DEBORA ERB HOLETS-ROSSI RN, CRNP

Table of content: MRS. DEBORA ERB HOLETS-ROSSI RN, CRNP (NPI 1356536924)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356536924 NPI number — MRS. DEBORA ERB HOLETS-ROSSI RN, CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLETS-ROSSI
Provider First Name:
DEBORA
Provider Middle Name:
ERB
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN, CRNP
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:
1356536924
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
920 WINTER ST
Provider Second Line Business Mailing Address:
3W-16
Provider Business Mailing Address City Name:
WALTHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02451-1521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-699-2924
Provider Business Mailing Address Fax Number:
781-699-4322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
562 SHEARER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-2746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-832-8061
Provider Business Practice Location Address Fax Number:
724-832-9311
Provider Enumeration Date:
09/07/2007

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: 163W00000X , with the licence number:  RN260235L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2100X , with the licence number: SP009492 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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