Provider Demographics
NPI:1215989884
Name:HOLCOMBE, DORENE MARION (CRNP)
Entity type:Individual
Prefix:
First Name:DORENE
Middle Name:MARION
Last Name:HOLCOMBE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PYLESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21132-1404
Mailing Address - Country:US
Mailing Address - Phone:410-452-8642
Mailing Address - Fax:
Practice Address - Street 1:600 N WOLFE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0005
Practice Address - Country:US
Practice Address - Phone:410-955-9434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR118883363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD118802000Medicaid
MD118802000Medicaid
MD168507ZABUMedicare PIN