MEDICARE: KATHERINE HOLMAN FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	26NJ00035900	NJ
2	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist	95001319	CA

General Provider Information

NPI Number	:	1770679839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE HOLMAN FNP

Provider Business Mailing Address
First Line	:	5838 EDISON PLACE
Second Line	:	SUITE 100
City	:	CARLSBAD
State	:	CA
Zip	:	92008-5520
Country	:	US
Telephone Number	:	760-300-3664
Fax Number	:	760-444-2211

Provider Business Practice Location Address
First Line	:	4929 WILSHIRE BLVD STE 510
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-3820
Country	:	US
Telephone Number	:	562-904-3999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	07/21/2022

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