1467579821 NPI number — MS. ROXANNE MARIE HOLTHAUS FNP

Table of content: MS. ROXANNE MARIE HOLTHAUS FNP (NPI 1467579821)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467579821 NPI number — MS. ROXANNE MARIE HOLTHAUS FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLTHAUS
Provider First Name:
ROXANNE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
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:
1467579821
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 COLLEGE CIR
Provider Second Line Business Mailing Address:
LADERDALE CENTER FOR STUDENT HEALTH AND COUNSELING
Provider Business Mailing Address City Name:
GENESEO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14454-1401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-245-5736
Provider Business Mailing Address Fax Number:
585-245-5744

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 COLLEGE CIR
Provider Second Line Business Practice Location Address:
LADERDALE CENTER FOR STUDENT HEALTH AND COUNSELING
Provider Business Practice Location Address City Name:
GENESEO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14454-1401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-245-5736
Provider Business Practice Location Address Fax Number:
585-245-5744
Provider Enumeration Date:
03/23/2007

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: 363LF0000X , with the licence number:  332170 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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