Provider Demographics
NPI:1598452658
Name:HOLCOMB, DOUGLAS D (RN)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:D
Last Name:HOLCOMB
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:DOUGLAS
Other - Middle Name:D
Other - Last Name:HOLCOMB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DOUGLAS D HOLCOMB
Mailing Address - Street 1:5927 N PINEGROVE DR
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-8986
Mailing Address - Country:US
Mailing Address - Phone:360-536-5432
Mailing Address - Fax:
Practice Address - Street 1:418 E LAKESIDE AVE STE 6 - 1
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2805
Practice Address - Country:US
Practice Address - Phone:360-536-5432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID49111163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health