Individual
TRAVIS HOLM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
24276 AIRPORT RD, EAGLE BUTTE, SD 57625
(605) 964-0704
Mailing address
PO BOX 765, EAGLE BUTTE, SD 57625-0765
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R044272
SD
Other
Enumeration date
10/02/2014
Last updated
10/02/2014
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