Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | H160217 | IA |
NPI | 1003414004 |
---|---|
Provider Name | Dr. Daniel Timothy Holthaus |
First Address | Iowa City, IA 52246-4142 |
Second Address | Iowa City, IA 52246-4142 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2020 |
Last Update Date | 12/10/2020 |