Individual
BROOKLEY VALENTINE HOLTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PAC
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA00818
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0192176
WA LABOR INDUSTRIES
WA
01
—
080727006
REGENCE BCBS
OR
01
—
P00186774
RR MEDICARE
—
Enumeration date
11/10/2005
Last updated
12/14/2017
Update your record
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