Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | TD60599824 | WA |
N | 208000000X | Pediatrician | MD450033 | PA |
Y | 2080P0214X | Pediatric Pulmonologist | A145173 | CA |
N | 2080P0214X | Pediatric Pulmonologist | MD450033 | PA |
NPI | 1104052661 |
---|---|
Provider Name | Dr. Kristel Britt Holmblad |
First Address | Moses Lake, WA 98837-2238 |
Second Address | Modesto, CA 95356-9781 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2009 |
Last Update Date | 07/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1104052661 | (05) | CA |
1104052661 | (05) | WA |
P01683022 | RR PTAN WVH (01) | WA |