Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | AHC-MID-LIC-867 | MT |
NPI | 1023453834 |
---|---|
Provider Name | Heather Lauren Holman |
First Address | Bigfork, MT 59911-6338 |
Second Address | Kalispell, MT 59901-3948 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2013 |
Last Update Date | 07/05/2013 |