Provider Demographics
NPI:1275040313
Name:HOLMBERG, NIKOLAUS
Entity Type:Individual
Prefix:
First Name:NIKOLAUS
Middle Name:
Last Name:HOLMBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 TURNER LN
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-5606
Mailing Address - Country:US
Mailing Address - Phone:864-200-2425
Mailing Address - Fax:
Practice Address - Street 1:7 TURNER LN
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-5606
Practice Address - Country:US
Practice Address - Phone:864-200-2425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer