Provider Demographics
NPI:1700924040
Name:HOLZE, LAUREL BETH (PA)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:BETH
Last Name:HOLZE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 S ARLINGTON HTS RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005
Mailing Address - Country:US
Mailing Address - Phone:847-439-1005
Mailing Address - Fax:847-439-7555
Practice Address - Street 1:1415 S ARLINGTON HTS RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HTS
Practice Address - State:IL
Practice Address - Zip Code:60005
Practice Address - Country:US
Practice Address - Phone:847-439-1005
Practice Address - Fax:847-439-7555
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCOOO2389363A00000X
IL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDPA52330OtherCDS
MDMW0677762OtherDEA