Provider Demographics
NPI:1003414004
Name:HOLTHAUS, DANIEL TIMOTHY (AGNP)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:TIMOTHY
Last Name:HOLTHAUS
Suffix:
Gender:M
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 MCKINLEY PL
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246-4142
Mailing Address - Country:US
Mailing Address - Phone:563-379-2100
Mailing Address - Fax:
Practice Address - Street 1:1403 MCKINLEY PL
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52246-4142
Practice Address - Country:US
Practice Address - Phone:563-379-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH160217363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health