Provider Demographics
NPI:1538980487
Name:HOLZBAUGH, VALERIE RENE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:VALERIE
Middle Name:RENE
Last Name:HOLZBAUGH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4701 SANDY OAK LN
Mailing Address - Street 2:
Mailing Address - City:NEWALLA
Mailing Address - State:OK
Mailing Address - Zip Code:74857-8825
Mailing Address - Country:US
Mailing Address - Phone:405-651-4549
Mailing Address - Fax:
Practice Address - Street 1:4701 SANDY OAK LN
Practice Address - Street 2:
Practice Address - City:NEWALLA
Practice Address - State:OK
Practice Address - Zip Code:74857-8825
Practice Address - Country:US
Practice Address - Phone:405-651-4549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5378363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant