Healthcare Provider Details

I. General information

NPI: 1528475951
Provider Name (Legal Business Name): MARY JOSEPHINE HOLUBA MSN, RN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 07/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ORLEANS ST BLOOMBERG 11 NORTH
BALTIMORE MD
21287-0010
US

IV. Provider business mailing address

671 SAINT PAUL ST APT. D
BALTIMORE MD
21202-2383
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-8751
  • Fax:
Mailing address:
  • Phone: 201-248-2532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR202572
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR202572
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: