Healthcare Provider Details

I. General information

NPI: 1669296380
Provider Name (Legal Business Name): ELIZABETH HOLZHAUSEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2024
Last Update Date: 11/09/2024
Certification Date: 11/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 S STATE ST
FRANKLIN IN
46131-2552
US

IV. Provider business mailing address

3512 STELLHORN RD
FORT WAYNE IN
46815-4631
US

V. Phone/Fax

Practice location:
  • Phone: 317-736-6414
  • Fax:
Mailing address:
  • Phone: 317-755-9709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71016004A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: