Healthcare Provider Details

I. General information

NPI: 1154773810
Provider Name (Legal Business Name): JOSEPH MORRIS HOLCOMB CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 09/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 W COLLEGE AVE
MARQUETTE MI
49855-2736
US

IV. Provider business mailing address

237 ACORN OAKS CIR APT 103
CHATTANOOGA TN
37405-2080
US

V. Phone/Fax

Practice location:
  • Phone: 906-225-3595
  • Fax:
Mailing address:
  • Phone: 906-630-0843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704320584
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: