Provider Demographics
NPI:1407955321
Name:WOJCIK, HOLLY M (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:M
Last Name:WOJCIK
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:588 N SUNRISE AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2842
Mailing Address - Country:US
Mailing Address - Phone:916-781-9885
Mailing Address - Fax:916-781-7923
Practice Address - Street 1:588 N SUNRISE AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2842
Practice Address - Country:US
Practice Address - Phone:916-781-9885
Practice Address - Fax:916-781-7923
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA323964207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA222148072Medicare ID - Type Unspecified
SS6432Medicare UPIN