Provider Demographics
NPI:1538492921
Name:HOLMAN, AMY (CRNA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:HOLMAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:FOLTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:813 LEONARDS WAY
Mailing Address - Street 2:
Mailing Address - City:ARGUSVILLE
Mailing Address - State:ND
Mailing Address - Zip Code:58005-9602
Mailing Address - Country:US
Mailing Address - Phone:701-484-5056
Mailing Address - Fax:701-484-9355
Practice Address - Street 1:737 BROADWAY N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-4421
Practice Address - Country:US
Practice Address - Phone:701-234-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR29774367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDN714690Medicare PIN