MEDICARE: MRS. PATRICIA L. HOLMQUIST LADC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	540	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	540	OTHER	NE	CHEMICAL DEPENDENCY COUNS

General Provider Information

NPI Number	:	1992888358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA L. HOLMQUIST LADC

Provider Business Mailing Address
First Line	:	7635 MAPLE VILLAGE DR
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68510-2571
Country	:	US
Telephone Number	:	402-488-6679
Fax Number	:

Provider Business Practice Location Address
First Line	:	2130 S 17TH ST
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68502-3750
Country	:	US
Telephone Number	:	402-488-6679
Fax Number	:

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

Provider Enumeration Date	:	10/21/2006
Last Update Date	:	01/11/2008

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