Provider Demographics
NPI:1558301416
Name:HOLCOMB, BRENDA G (RNFA)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:G
Last Name:HOLCOMB
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 OAK PARK BLVD
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8991
Mailing Address - Country:US
Mailing Address - Phone:337-494-6799
Mailing Address - Fax:337-430-6950
Practice Address - Street 1:1717 OAK PARK BLVD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8991
Practice Address - Country:US
Practice Address - Phone:337-494-6799
Practice Address - Fax:337-430-6950
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LARN033420363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical