Healthcare Provider Details

I. General information

NPI: 1831829845
Provider Name (Legal Business Name): CHELSEA M HOLTMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 06/13/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 INTREPID LN
SYRACUSE NY
13205-2544
US

IV. Provider business mailing address

7355 VAN BUREN RD
BALDWINSVILLE NY
13027-9078
US

V. Phone/Fax

Practice location:
  • Phone: 315-469-8700
  • Fax:
Mailing address:
  • Phone: 315-720-5276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number349725
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: