Provider Demographics
NPI:1437350444
Name:HOLSCLAW, CONNIE M (RN)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:M
Last Name:HOLSCLAW
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 1:1075 N CURTIS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-1300
Mailing Address - Country:US
Mailing Address - Phone:208-323-0031
Mailing Address - Fax:208-323-0064
Practice Address - Street 1:1075 N CURTIS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1300
Practice Address - Country:US
Practice Address - Phone:208-323-0031
Practice Address - Fax:208-323-0064
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-10853163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDN-10853OtherREGISTERED NURSE