Provider Demographics
NPI:1649504747
Name:BIRKHOLZ, DENISE (CNIM)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:BIRKHOLZ
Suffix:
Gender:F
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11227 STELLA BLUE DR
Mailing Address - Street 2:
Mailing Address - City:LOLO
Mailing Address - State:MT
Mailing Address - Zip Code:59847-8490
Mailing Address - Country:US
Mailing Address - Phone:303-594-5123
Mailing Address - Fax:
Practice Address - Street 1:11227 STELLA BLUE DR
Practice Address - Street 2:
Practice Address - City:LOLO
Practice Address - State:MT
Practice Address - Zip Code:59847-8490
Practice Address - Country:US
Practice Address - Phone:303-594-5123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2138 CNIM2472E0500X, 246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
No2472E0500XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherEEG
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1912171760OtherGROUP NPI