Nicholas Ray Von Holten, PA-C

NPI #1063054278 in Bloomington, Illinois

Provider Information

NPI Number: 1063054278
Entity Type: Individual
Name: Nicholas Ray Von Holten, PA-C
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Physician Assistant
Credential: PA-C
Enumeration Date: Oct 9, 2019
Last Updated: Oct 9, 2019

Practice Location

Address: 1111 TRINITY LN STE 111
City: Bloomington
State: Illinois
ZIP Code: 61704-8112
Phone: (309) 663-6461

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant - Surgical — Surgical	363AS0400X
Physician Assistant	363A00000X	Primary
Physician Assistant - Medical — Medical	363AM0700X

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