Healthcare Provider Details

I. General information

NPI: 1679733208
Provider Name (Legal Business Name): LINDA S HOLCOMB MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 03/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 FULMER RD
MISHAWAKA IN
46544-6911
US

IV. Provider business mailing address

615 FULMER RD
MISHAWAKA IN
46544-6911
US

V. Phone/Fax

Practice location:
  • Phone: 574-252-3085
  • Fax: 574-255-4342
Mailing address:
  • Phone: 574-252-3085
  • Fax: 574-255-4342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71002673A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: