Healthcare Provider Details

I. General information

NPI: 1164534517
Provider Name (Legal Business Name): BILL HOLSHOUSER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 FAIRGROVE CHURCH RD
HICKORY NC
28602-9617
US

IV. Provider business mailing address

1740 29TH AVENUE PL NE
HICKORY NC
28601-7493
US

V. Phone/Fax

Practice location:
  • Phone: 828-326-3809
  • Fax: 828-326-3371
Mailing address:
  • Phone: 828-326-3809
  • Fax: 828-326-3371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number27779
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: