Provider Demographics
NPI:1538859491
Name:HOLCOMB, MA RENEE (NP)
Entity type:Individual
Prefix:
First Name:MA RENEE
Middle Name:
Last Name:HOLCOMB
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3709 DRAKESHIRE DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-1908
Mailing Address - Country:US
Mailing Address - Phone:559-326-4676
Mailing Address - Fax:
Practice Address - Street 1:3709 DRAKESHIRE DR
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-1908
Practice Address - Country:US
Practice Address - Phone:559-326-4676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95025106363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner