Healthcare Provider Details

I. General information

NPI: 1023080637
Provider Name (Legal Business Name): NANCY LOUISE HOLUB CNM IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR
SAN DIEGO CA
92134-1098
US

IV. Provider business mailing address

3762 VISTA DE LA BAHIA
SAN DIEGO CA
92117-5747
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-7004
  • Fax:
Mailing address:
  • Phone: 619-524-6346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number406343
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: