Provider Demographics
NPI:1023168879
Name:HOLZER, DIANE RENE (PA-C)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:RENE
Last Name:HOLZER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 N MCDOWELL BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-6503
Mailing Address - Country:US
Mailing Address - Phone:707-559-7500
Mailing Address - Fax:
Practice Address - Street 1:6 B STREET
Practice Address - Street 2:
Practice Address - City:POINT REYES STATION
Practice Address - State:CA
Practice Address - Zip Code:94956
Practice Address - Country:US
Practice Address - Phone:415-663-8666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13354363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant