Healthcare Provider Details

I. General information

NPI: 1326089988
Provider Name (Legal Business Name): SUZANNE M HOLM NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 RUSSELL ST.
CRAIG CO
81625-2019
US

IV. Provider business mailing address

745 RUSSELL ST.
CRAIG CO
81625-2019
US

V. Phone/Fax

Practice location:
  • Phone: 970-824-8233
  • Fax: 970-824-2548
Mailing address:
  • Phone: 970-824-8233
  • Fax: 970-824-2548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP2028832
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number990241
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: