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General NPI Number Information
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NPI Number | 1962143164
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Entity Type | Individual
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Provider Name | SAMANTHA CHRISTINE HOLZHAUER LPN
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Gender | Female
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Dates
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Enumeration Date | 04/05/2022
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Last Update Date | 04/05/2022
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Provider Practice Location Address
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Address Line | 50 MERAMEC TRAIL DR
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City | BALLWIN
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State | MO
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Zip | 63021-3303
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Country | US
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Telephone | 636-923-2396
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Fax | 636-923-2371
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Provider Business Mailing Address
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Address Line | 1177 TAHOE PL
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City | PACIFIC
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State | MO
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Zip | 63069-3658
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Country | US
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Telephone | 314-208-1137
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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 | 364SG0600X
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Taxonomy Name | Gerontology Clinical Nurse Specialist
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License Number | 2017030578
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License Number State | MO
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