Provider Demographics
NPI:1679176259
Name:HOLTMAN, JENNIFER P
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:P
Last Name:HOLTMAN
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 1:6233 ELKWATER CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45248-3902
Mailing Address - Country:US
Mailing Address - Phone:513-578-9571
Mailing Address - Fax:
Practice Address - Street 1:6233 ELKWATER CT
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-3902
Practice Address - Country:US
Practice Address - Phone:513-578-9571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3124558Medicaid