Healthcare Provider Details

I. General information

NPI: 1396074746
Provider Name (Legal Business Name): JENNIFER LYNN HOLMGREN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2009
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 N 51ST AVE STE 4
PHOENIX AZ
85031-1237
US

IV. Provider business mailing address

4700 N 51ST AVE STE 4
PHOENIX AZ
85031-1237
US

V. Phone/Fax

Practice location:
  • Phone: 623-846-7575
  • Fax: 623-247-6386
Mailing address:
  • Phone: 623-846-7575
  • Fax: 623-247-6386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number6000
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: