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General NPI Number Information
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NPI Number | 1710232699
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Entity Type | Individual
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Provider Name | SARA GRACE HOLMBERG ANP
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Gender | Female
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Dates
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Enumeration Date | 07/17/2012
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Last Update Date | 05/12/2020
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Provider Practice Location Address
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Address Line | 403 STAGELINE RD
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City | HUDSON
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State | WI
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Zip | 54016-7848
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Country | US
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Telephone | 715-531-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 504 MC CUTCHEON RD
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City | HUDSON
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State | WI
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Zip | 54016-7009
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Country | US
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Telephone | 715-386-4052
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Fax |
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | R 179752-9
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 7900
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License Number State | WI
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