NICHOLAS RAY VON HOLTEN (NPI# 1063054278) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063054278 |
| Entity Type | Individual |
| Full Name | NICHOLAS RAY VON HOLTEN |
| Credential | PA-C |
| Practice Address |
1111 Trinity Ln Ste 111 Bloomington IL 61704-8112 |
| Mailing Address |
21 Prenzler Dr Bloomington IL 61704-1299 |
| Practice Telephone | 3096636461 |
| Mailing Telephone | 3098246658 |
| Enumeration Date | 2019-10-09 |
| Last Update Date | 2019-10-09 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 085.007292 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
085.007292 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
085.007292 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1111 TRINITY LN STE 111 |
| City | BLOOMINGTON |
| State | IL |
| Zip Code | 61704-8112 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609875798 | Kimberly Kelleher Rhoda | Occupational Therapist | 1111 Trinity Ln Ste 111, Bloomington, IL 61704-8112 | 2005-07-20 |
| 1316582273 | Nicole Christine Bermudes | Orthopaedic Surgery | 1111 Trinity Ln Ste 111, Bloomington, IL 61704-8112 | 2019-11-14 |
| 1134690522 | Matthew A Kresnicka | Physical Therapist | 1111 Trinity Ln Ste 111, Bloomington, IL 61704-8112 | 2018-12-10 |
| 1871082826 | Jessica Amanda Tobias | Student in an Organized Health Care Education/Training Program | 1111 Trinity Ln Ste 111, Bloomington, IL 61704-8112 | 2018-05-04 |
| 1164939179 | Lukas Dominic Manieri | Specialist/Technologist | 1111 Trinity Ln Ste 111, Bloomington, IL 61704-8112 | 2017-12-29 |
| 1083124846 | Lucas B Roth | Physician Assistant | 1111 Trinity Ln Ste 111, Bloomington, IL 61704 | 2017-10-06 |
| 1467961706 | Sandra A Fader | Nurse Practitioner | 1111 Trinity Ln Ste 111, Bloomington, IL 61704-8112 | 2017-09-28 |
| 1356732101 | Brian A Schrock | Physician Assistant | 1111 Trinity Ln Ste 111, Bloomington, IL 61704-8112 | 2015-02-16 |
| 1144633579 | Ashley R Anderson | Physical Therapist | 1111 Trinity Ln Ste 111, Bloomington, IL 61704-8112 | 2014-06-03 |
| 1801146444 | Jonathon C Crowley | Physical Therapist | 1111 Trinity Ln Ste 111, Bloomington, IL 61704-8112 | 2012-09-11 |
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| 1396093977 | Bhawna Gupta | Physical Therapist | 2200 East Washington Street, Bloomington, IL 61704 | 2012-08-29 |
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| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
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| 1730619487 | Elise Nicole Lill | Physician Assistant | 4300 Market Pte Dr Ste 100, Bloomington, MN 55435-5435 | 2017-06-15 |
| 1528417557 | Kathryn Shalbrack | Physician Assistant | 4300 Marketpointe Dr, Bloomington, MN 55435-5423 | 2016-06-09 |
| 1740634203 | Alfonso Luna IIi | Physician Assistant | 657 S Lancewood Ave, Bloomington, CA 92316-1336 | 2016-04-20 |
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| 1760865133 | Patrick D Machacek | Physician Assistant | 10633 Vincent Ave S, Bloomington, MN 55431-3733 | 2015-07-03 |
| 1558740803 | Samuel Johnson | Physician Assistant | 2901 Metro Drive, Suite 527, Bloomington, MN 55122 | 2015-05-20 |
| Find all providers in BLOOMINGTON | ||||
| City | BLOOMINGTON |
| Zip Code | 61704 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.