Basic Information
| Provider Information | |||||||||
| NPI: | 1619579737 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLMGREN | ||||||||
| FirstName: | BROOKE | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2971 BRONCO DR | ||||||||
| Address2: | |||||||||
| City: | NEW FRANKLIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442169736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308588372 | ||||||||
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| Practice Location | |||||||||
| Address1: | 141 N FORGE ST | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443041407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303753000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2020 | ||||||||
| LastUpdateDate: | 11/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 50.006650RX | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.