Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 042-0011321 | VT |
N | 111NI0900X | Internist | 042-0011321 | VT |
Y | 207RX0202X | Medical Oncology | 12846 | NV |
NPI | 1093937054 |
---|---|
Provider Name | Dr. Regan Holdridge |
First Address | Henderson, NV 89014-6692 |
Second Address | Henderson, NV 89074 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 23/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
371315 | (05) | AZ |