Healthcare Provider Details

I. General information

NPI: 1659051092
Provider Name (Legal Business Name): EMILY JEAN HOLMQUIST PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2023
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 S 200 E
SLC UT
84111-3835
US

IV. Provider business mailing address

309 E 2ND ST
POMONA CA
91766-1854
US

V. Phone/Fax

Practice location:
  • Phone: 801-359-2256
  • Fax:
Mailing address:
  • Phone: 909-623-6116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number13562847-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: