Provider Demographics
NPI:1427653484
Name:HOLTZ, JENNIFER (CDSP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HOLTZ
Suffix:
Gender:F
Credentials:CDSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 14TH ST NW LOT 56
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-4203
Mailing Address - Country:US
Mailing Address - Phone:701-351-8362
Mailing Address - Fax:
Practice Address - Street 1:1223 14TH ST NW LOT 46
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-4203
Practice Address - Country:US
Practice Address - Phone:701-351-7369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide