=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225828593
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATELYNN MARIE HOLTZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2025
-----------------------------------------------------
Last Update Date | 05/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2208 N WEBB RD UNIT 4
-----------------------------------------------------
City | GRAND ISLAND
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68803-1756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-381-1690
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2111 ROAD L
-----------------------------------------------------
City | BENEDICT
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68316-9046
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-710-0274
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 372500000X
-----------------------------------------------------
Taxonomy Name | Chore Provider
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------