Healthcare Provider Details

I. General information

NPI: 1417220781
Provider Name (Legal Business Name): LAURA A HOLTZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2012
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 21ST CIR
WISNER NE
68791-2044
US

IV. Provider business mailing address

2104 21ST CIRCLE PO BOX 779 ELKHORN LOGAN VALLEY PUBLIC HEALTH DEPARTMENT
WISNER NE
68791-0779
US

V. Phone/Fax

Practice location:
  • Phone: 402-529-2233
  • Fax: 402-529-2211
Mailing address:
  • Phone: 402-529-2233
  • Fax: 402-529-2211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number32352
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: