MEDICARE: SARAH LYN HOLDA 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	363L00000X	Nurse Practitioner	4704237499	MI
2	363LF0000X	Family Nurse Practitioner	4704237499	MI
3	363LW0102X	Women's Health Nurse Practitioner	4704237499	MI

General Provider Information

NPI Number	:	1376653303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH LYN HOLDA NP

Provider Business Mailing Address
First Line	:	3621 S STATE ST
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48108-1633
Country	:	US
Telephone Number	:	734-647-5299
Fax Number	:

Provider Business Practice Location Address
First Line	:	14700 E OLD US HIGHWAY 12
Second Line	:
City	:	CHELSEA
State	:	MI
Zip	:	48118-1185
Country	:	US
Telephone Number	:	734-763-6295
Fax Number	:

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	03/28/2024

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