Provider Demographics
NPI:1386420883
Name:HOLBERT, ELLA MAEVE (PA)
Entity type:Individual
Prefix:
First Name:ELLA
Middle Name:MAEVE
Last Name:HOLBERT
Suffix:
Gender:F
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:1 EDMUNDSON PL STE 500
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-4619
Mailing Address - Country:US
Mailing Address - Phone:712-388-0155
Mailing Address - Fax:712-323-3252
Practice Address - Street 1:7710 MERCY RD STE 2000
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2323
Practice Address - Country:US
Practice Address - Phone:402-717-7222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2024-09-11
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant