Healthcare Provider Details

I. General information

NPI: 1215989884
Provider Name (Legal Business Name): DORENE MARION HOLCOMBE C.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 03/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

1100 RIDGE RD
PYLESVILLE MD
21132-1404
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-9434
  • Fax:
Mailing address:
  • Phone: 410-452-8642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR118883
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: