Provider Demographics
NPI:1710100466
Name:HOLTZ, SHARON M (LMP)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:M
Last Name:HOLTZ
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 384
Mailing Address - Street 2:
Mailing Address - City:NEWMAN LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99025-0384
Mailing Address - Country:US
Mailing Address - Phone:509-226-1171
Mailing Address - Fax:
Practice Address - Street 1:12205 E 12TH AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-5461
Practice Address - Country:US
Practice Address - Phone:509-701-3028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013336174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist