Provider Demographics
NPI:1548822794
Name:HOLBIRD, MICHAELLE L
Entity type:Individual
Prefix:
First Name:MICHAELLE
Middle Name:L
Last Name:HOLBIRD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 S FALCON AVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74019-2237
Mailing Address - Country:US
Mailing Address - Phone:918-341-1000
Mailing Address - Fax:918-403-6309
Practice Address - Street 1:1910 S FALCON AVE
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74019-2237
Practice Address - Country:US
Practice Address - Phone:918-341-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK113173363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily