Healthcare Provider Details

I. General information

NPI: 1538492921
Provider Name (Legal Business Name): AMY HOLMAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY FOLTZ

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 11/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 BROADWAY N
FARGO ND
58102-4421
US

IV. Provider business mailing address

813 LEONARDS WAY
ARGUSVILLE ND
58005-9602
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-2000
  • Fax:
Mailing address:
  • Phone: 701-484-5056
  • Fax: 701-484-9355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR29774
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: