Provider Demographics
NPI:1639195712
Name:HOLZAPFEL, VICTORIA R (CNP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:R
Last Name:HOLZAPFEL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 E MAIN ST
Mailing Address - Street 2:STE G
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640-1788
Mailing Address - Country:US
Mailing Address - Phone:740-577-3043
Mailing Address - Fax:740-577-3065
Practice Address - Street 1:345 E MAIN ST
Practice Address - Street 2:STE G
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-1788
Practice Address - Country:US
Practice Address - Phone:740-577-3043
Practice Address - Fax:740-577-3065
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.06887-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000204511OtherOH MEDICAID UNISON
OH2308489OtherMOLINA MEDICAID
OH2308489Medicaid
WV7102205000Medicaid
500022608OtherRR MEDICARE
OHNP09962Medicare PIN
500022608OtherRR MEDICARE