Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | DP00350 | OR |
Y | 222Z00000X | Podiatrist | DP00350 | OR |
NPI | 1013935360 |
---|---|
Provider Name | Dr. Heather Aileen Holdermann |
First Address | Medford, OR 97504-8144 |
Second Address | Medford, OR 97504-8144 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 23/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
299113 | (05) | OR |
U88650 | (02) | OR |