MEDICARE: STEPHEN B HOLDERMAN APRN

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	363L00000X	Nurse Practitioner	900375	NC
2	363LA2200X	Adult Health Nurse Practitioner	052864-23	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255339636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN B HOLDERMAN APRN

Provider Business Mailing Address
First Line	:	1 MEDICAL CENTER DR
Second Line	:	DHMC DEPARTMENT OF CARDIOLOGY
City	:	LEBANON
State	:	NH
Zip	:	03756-1000
Country	:	US
Telephone Number	:	603-650-7837
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 MEDICAL CENTER DR
Second Line	:	DHMC DEPARTMENT OF CARDIOLOGY
City	:	LEBANON
State	:	NH
Zip	:	03756-1000
Country	:	US
Telephone Number	:	603-650-7837
Fax Number	:

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

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	11/21/2011

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