Healthcare Provider Details

I. General information

NPI: 1174728083
Provider Name (Legal Business Name): DEBORAH ANN HOLDEMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 08/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3232 ELM ST
OAKLAND CA
94609-3050
US

IV. Provider business mailing address

5517 LAWTON AVE
OAKLAND CA
94618-1508
US

V. Phone/Fax

Practice location:
  • Phone: 510-869-8761
  • Fax: 510-869-6903
Mailing address:
  • Phone: 510-652-6697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number441923NP4995
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: