Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 11024 | WI |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 209021881 | IL |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 4704317104 | MI |
N | 363LP0200X | Nurse Practitioner - Pediatrics | 209021881 | IL |
N | 363LP0200X | Nurse Practitioner - Pediatrics | 4704317104 | MI |
Y | 363LP0222X | Nurse Practitioner Pediatrics (Critical Care) | 11024 | WI |
N | 363LP0222X | Nurse Practitioner Pediatrics (Critical Care) | 259319-30 | WI |
NPI | 1023789583 |
---|---|
Provider Name | Gabriel Holtman |
First Address | Milwaukee, WI 53226-4874 |
Second Address | Milwaukee, WI 53226-4874 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2021 |
Last Update Date | 04/10/2021 |