Healthcare Provider Details

I. General information

NPI: 1700266830
Provider Name (Legal Business Name): MRS. KATHLEEN MICHELLE HOLZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS KATHLEEN MICHELLE EASTER

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 06/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3206 TENNESSEE ST NE
ALBUQUERQUE NM
87110-2435
US

IV. Provider business mailing address

3206 TENNESSEE ST NE
ALBUQUERQUE NM
87110-2435
US

V. Phone/Fax

Practice location:
  • Phone: 505-450-8870
  • Fax:
Mailing address:
  • Phone: 505-450-8870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: