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General NPI Number Information
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NPI Number | 1013765478
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Entity Type | Individual
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Provider Name | KATRINA HOLMBERG RN
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Gender | Female
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Dates
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Enumeration Date | 05/10/2024
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Last Update Date | 05/10/2024
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Provider Practice Location Address
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Address Line | 32961 MIDDLEBELT RD
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-1729
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Country | US
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Telephone | 800-395-3223
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Fax | 248-620-6405
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Provider Business Mailing Address
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Address Line | 6549 TOWN CENTER DR STE A
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City | CLARKSTON
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State | MI
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Zip | 48346-4824
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Country | US
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Telephone | 800-395-3223
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Fax | 248-620-6405
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704410509
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License Number State | MI
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