Healthcare Provider Details

I. General information

NPI: 1780826404
Provider Name (Legal Business Name): JUDITH LYNN HOLINSWORTH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2009
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6069 TIMBER RIDGE DRIVE
MAGALIA CA
95954
US

IV. Provider business mailing address

6069 TIMBER RIDGE DR
MAGALIA CA
95954
US

V. Phone/Fax

Practice location:
  • Phone: 530-873-2835
  • Fax:
Mailing address:
  • Phone: 530-873-2835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number727796
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: