Healthcare Provider Details

I. General information

NPI: 1447402318
Provider Name (Legal Business Name): LORI ANN HOLENCIK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2008
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 STUDENT HEALTH CENTER
UNIVERSITY PARK PA
16802
US

IV. Provider business mailing address

308 STUDENT HEALTH CTR
UNIVERSITY PARK PA
16802-2129
US

V. Phone/Fax

Practice location:
  • Phone: 814-863-6747
  • Fax: 814-863-8464
Mailing address:
  • Phone: 814-863-6747
  • Fax: 814-863-8464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-11181
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: