Provider Demographics
NPI:1083073597
Name:HABERMAN, HOLLY
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:HABERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55149 KNOX AVE
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:NE
Mailing Address - Zip Code:68730-4144
Mailing Address - Country:US
Mailing Address - Phone:402-388-2374
Mailing Address - Fax:
Practice Address - Street 1:409 SUMMIT ST
Practice Address - Street 2:SUITE # 3400
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-3734
Practice Address - Country:US
Practice Address - Phone:605-260-0310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEXXXXX363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily