Individual
SUSAN J HOLTKAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
5409 AVENUE O, FORT MADISON, IA 52627-9601
(319) 376-2134
(319) 376-2188
Mailing address
5409 AVENUE O, FORT MADISON, IA 52627-9601
(319) 376-2134
(319) 376-2188
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
C134848
IA
364SP0200X
Pediatric Clinical Nurse Specialist
Primary
C134848
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
185413
BLUE SHIELD
MO
01
—
431560263
TRICARE WEST
MO
01
—
739476
HEALTHLINK
MO
01
—
P00805205
RAILROAD MEDICARE
—
Enumeration date
04/17/2006
Last updated
08/13/2024
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