Provider Demographics
NPI:1922005412
Name:HOLM, GREGORY BERNT (PHD, ARNP-C, FAANP)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:BERNT
Last Name:HOLM
Suffix:
Gender:M
Credentials:PHD, ARNP-C, FAANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:CRAIG
Mailing Address - State:CO
Mailing Address - Zip Code:81625-1920
Mailing Address - Country:US
Mailing Address - Phone:970-826-0911
Mailing Address - Fax:970-826-0910
Practice Address - Street 1:595 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:CRAIG
Practice Address - State:CO
Practice Address - Zip Code:81625-1920
Practice Address - Country:US
Practice Address - Phone:970-826-0911
Practice Address - Fax:970-826-0910
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1801062363L00000X
COAPN.0990175-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO001446100Medicaid