Healthcare Provider Details

I. General information

NPI: 1376886168
Provider Name (Legal Business Name): ELAINE HOLT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2013
Last Update Date: 04/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 AYER RD
HARVARD MA
01451-1131
US

IV. Provider business mailing address

233 AYER RD
HARVARD MA
01451-1131
US

V. Phone/Fax

Practice location:
  • Phone: 978-772-0698
  • Fax:
Mailing address:
  • Phone: 978-772-0698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF1012152
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: