Provider Demographics
NPI:1457372013
Name:HOLTORF, DEBORAH LEES (PNP)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LEES
Last Name:HOLTORF
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 OLD BAY RD
Mailing Address - Street 2:
Mailing Address - City:BOLTON
Mailing Address - State:MA
Mailing Address - Zip Code:01740-1253
Mailing Address - Country:US
Mailing Address - Phone:978-779-5337
Mailing Address - Fax:
Practice Address - Street 1:1 JOSLIN PL
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5306
Practice Address - Country:US
Practice Address - Phone:617-732-2603
Practice Address - Fax:617-732-2451
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA107031363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0317101Medicaid
MANP3968OtherBLUECROSS/BLUESHIELD
MANP3968OtherBLUECROSS/BLUESHIELD
P72654Medicare UPIN