Individual
MS. DIANE P HOLZEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN,C
Contact information
Practice address
12000 STONE LAKE ROAD, DULCE, NM 87528-0187
(505) 759-7233
(505) 759-7294
Mailing address
PO BOX 187, DULCE, NM 87528-0187
(505) 759-7233
(505) 759-7294
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R17040
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000K3526
—
NM
01
—
HSZ196
MEDICARE PART B
NM
Enumeration date
07/25/2006
Last updated
06/23/2008
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