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General NPI Number Information
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NPI Number | 1801767637
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Entity Type | Individual
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Provider Name | DIXIE HOLSTEN PPRC
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Gender | Female
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Dates
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Enumeration Date | 09/15/2025
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 151 N 3RD AVE STE 330
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City | POCATELLO
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State | ID
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Zip | 83201-6369
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Country | US
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Telephone | 208-242-3771
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Fax | 208-242-3772
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Provider Business Mailing Address
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Address Line | 5055 ARAPAHOE ST
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City | POCATELLO
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State | ID
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Zip | 83204-3773
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Country | US
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Telephone | 208-242-3771
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Fax | 208-242-3772
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 13184
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License Number State | ID
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