Individual
JACQUELINE HOLDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
221 S 6TH ST, TERRE HAUTE, IN 47807-4214
(812) 242-3105
(812) 242-3133
Mailing address
221 S 6TH ST, TERRE HAUTE, IN 47807-4214
(812) 242-3105
(812) 242-3133
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
02002477A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000224510
ANTHEM
—
05
—
200373360
—
IN
Enumeration date
08/25/2006
Last updated
08/18/2010
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