Healthcare Provider Details

I. General information

NPI: 1548569023
Provider Name (Legal Business Name): RULON B HOLMAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 03/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 N MARTIN LUTHER KING JR BLVD
CLOVIS NM
88101
US

IV. Provider business mailing address

PO BOX 98567
LAS VEGAS NV
89193-8567
US

V. Phone/Fax

Practice location:
  • Phone: 575-769-7152
  • Fax:
Mailing address:
  • Phone: 915-779-1716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA-01137
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: