Provider Demographics
NPI:1790039931
Name:HOLISTIC AND FAMILY HEALTHCARE
Entity Type:Organization
Organization Name:HOLISTIC AND FAMILY HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BLACKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:402-933-2222
Mailing Address - Street 1:535 FORTUNE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-3429
Mailing Address - Country:US
Mailing Address - Phone:402-933-2222
Mailing Address - Fax:402-505-3886
Practice Address - Street 1:535 FORTUNE DR STE 100
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-3429
Practice Address - Country:US
Practice Address - Phone:402-933-2222
Practice Address - Fax:402-505-3886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty