Provider Demographics
NPI:1518572098
Name:HOLTHAUS, LORI RENE
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:RENE
Last Name:HOLTHAUS
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 1:8110 VALLEY CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-1112
Mailing Address - Country:US
Mailing Address - Phone:513-328-6097
Mailing Address - Fax:
Practice Address - Street 1:8110 VALLEY CROSSING DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45247-1112
Practice Address - Country:US
Practice Address - Phone:513-328-6097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHM042471Medicaid