Healthcare Provider Details

I. General information

NPI: 1295496636
Provider Name (Legal Business Name): MEGAN HOLMBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2022
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 EAST AVE
TALLMADGE OH
44278-2340
US

IV. Provider business mailing address

30 HUNTER LN
CAMP HILL PA
17011-2499
US

V. Phone/Fax

Practice location:
  • Phone: 330-633-1150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN460591
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: