Provider Demographics
NPI:1396976023
Name:HOLDEMAN, ROBBIE
Entity type:Individual
Prefix:MRS
First Name:ROBBIE
Middle Name:
Last Name:HOLDEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROBBIE
Other - Middle Name:
Other - Last Name:HOLDEMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CASE MANAGER
Mailing Address - Street 1:510 S BROOKS AVE
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-4013
Mailing Address - Country:US
Mailing Address - Phone:307-660-2773
Mailing Address - Fax:307-464-3019
Practice Address - Street 1:510 S BROOKS AVE
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-4013
Practice Address - Country:US
Practice Address - Phone:307-660-2773
Practice Address - Fax:307-464-3019
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2015-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY171M00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator