Provider Demographics
NPI:1417220781
Name:HOLTZ, LAURA A (RN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:HOLTZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 21ST CIRCLE PO BOX 779
Mailing Address - Street 2:ELKHORN LOGAN VALLEY PUBLIC HEALTH DEPARTMENT
Mailing Address - City:WISNER
Mailing Address - State:NE
Mailing Address - Zip Code:68791-0779
Mailing Address - Country:US
Mailing Address - Phone:402-529-2233
Mailing Address - Fax:402-529-2211
Practice Address - Street 1:2104 21ST CIR
Practice Address - Street 2:
Practice Address - City:WISNER
Practice Address - State:NE
Practice Address - Zip Code:68791-2044
Practice Address - Country:US
Practice Address - Phone:402-529-2233
Practice Address - Fax:402-529-2211
Is Sole Proprietor?:No
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE32352163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse