Healthcare Provider Details

I. General information

NPI: 1346339108
Provider Name (Legal Business Name): PATRICIA HOLDERBACH CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 10/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PENN BLVD SUITE 201,2ND FLOOR
PHILA PA
19144-1476
US

IV. Provider business mailing address

101 E OLNEY AVE SUITE 505
PHILA PA
19120-2421
US

V. Phone/Fax

Practice location:
  • Phone: 215-951-8933
  • Fax: 215-951-8930
Mailing address:
  • Phone: 215-456-7000
  • Fax: 215-254-2599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP009182
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: