Provider Demographics
NPI:1083362123
Name:HOLZER, JULIANNA ELIZABETH
Entity Type:Individual
Prefix:
First Name:JULIANNA
Middle Name:ELIZABETH
Last Name:HOLZER
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 1:107 DES PLAINES AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-1003
Mailing Address - Country:US
Mailing Address - Phone:847-868-4961
Mailing Address - Fax:
Practice Address - Street 1:107 DES PLAINES AVE APT 1
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60130-1003
Practice Address - Country:US
Practice Address - Phone:847-868-4961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program