Healthcare Provider Details

I. General information

NPI: 1265001622
Provider Name (Legal Business Name): NICOLE M HOLM DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE KOCHAN

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 OAKLEAF WAY STE A
ALTOONA WI
54720-2217
US

IV. Provider business mailing address

1200 OAKLEAF WAY STE A
ALTOONA WI
54720-2217
US

V. Phone/Fax

Practice location:
  • Phone: 715-832-1700
  • Fax: 715-832-4187
Mailing address:
  • Phone: 715-832-1700
  • Fax: 715-832-4187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11250
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: