=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710100466
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHARON M HOLTZ LMP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12205 E 12TH AVE SUITE 3
-----------------------------------------------------
City | SPOKANE VALLEY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99206-5461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-701-3028
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 384
-----------------------------------------------------
City | NEWMAN LAKE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99025-0384
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-226-1171
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | MA00013336
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------