Healthcare Provider Details

I. General information

NPI: 1659209336
Provider Name (Legal Business Name): NICOLE MARIE HOLBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 42ND ST NW
MANDAN ND
58554-1108
US

IV. Provider business mailing address

203 3RD AVE NW
MANDAN ND
58554-3131
US

V. Phone/Fax

Practice location:
  • Phone: 320-630-9902
  • Fax:
Mailing address:
  • Phone: 320-630-9902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: