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1679749667 NPI number — MRS. NICOLE HOLZEM

NPI Number: 1679749667
Health Care Provider/Practitioner: MRS. NICOLE HOLZEM

Information about “1679749667” NPI (MRS. NICOLE HOLZEM) exists in 1679749667 in HTML format HTML  |  1679749667 in plain Text format TXT  |  1679749667 in PDF (Portable Document Format) PDF  |  1679749667 in an XML format XML  formats.

NPI Number : 1679749667 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1679749667",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HOLZEM",
    "FirstName": "NICOLE",
    "MiddleName": null,
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "704 W CROCKER ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WAUSAU",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "54401-2130",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "715-842-0575",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3107 WESTHILL DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WAUSAU",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "54401-3774",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "715-845-8444",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/30/2008",
    "LastUpdateDate": "10/24/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "314000000X",
        "TaxonomyName": "Skilled Nursing Facility",
        "LicenseNumber": "1419-019",
        "LicenseNumberStateCode": "WI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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