Healthcare Provider Details

I. General information

NPI: 1457728719
Provider Name (Legal Business Name): JOSHUA PETER HOLEWINSKI AGPCNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2015
Last Update Date: 08/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N NAPPANEE ST
ELKHART IN
46514-1957
US

IV. Provider business mailing address

2301 W LEXINGTON AVE APT. 101-1A
ELKHART IN
46514-1493
US

V. Phone/Fax

Practice location:
  • Phone: 574-522-0265
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71005687A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71005687B
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: