Healthcare Provider Details

I. General information

NPI: 1013376631
Provider Name (Legal Business Name): HOLLY THERESE LEHMANN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2016
Last Update Date: 02/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3780 SMUGGLER PL
BOULDER CO
80305-7248
US

IV. Provider business mailing address

3780 SMUGGLER PL
BOULDER CO
80305-7248
US

V. Phone/Fax

Practice location:
  • Phone: 843-338-0123
  • Fax:
Mailing address:
  • Phone: 843-338-0123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number0173295
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: