Healthcare Provider Details

I. General information

NPI: 1144585225
Provider Name (Legal Business Name): ERIN HOLCOMB APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 07/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 AVENUE B
SCOTTSBLUFF NE
69361-4303
US

IV. Provider business mailing address

3210 AVENUE B
SCOTTSBLUFF NE
69361-4303
US

V. Phone/Fax

Practice location:
  • Phone: 308-630-0800
  • Fax: 308-630-0842
Mailing address:
  • Phone: 308-630-0800
  • Fax: 308-630-0842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number111373
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: