Healthcare Provider Details

I. General information

NPI: 1568838878
Provider Name (Legal Business Name): LADONNA M HOLT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LADONNA M HOLT FNP

II. Dates (important events)

Enumeration Date: 08/20/2015
Last Update Date: 04/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E BARSTOW AVE
FRESNO CA
93710-5020
US

IV. Provider business mailing address

189 N CAROLINA AVE
CLOVIS CA
93611-5357
US

V. Phone/Fax

Practice location:
  • Phone: 559-486-5290
  • Fax:
Mailing address:
  • Phone: 559-797-6682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number745946
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: