Provider Demographics
NPI:1487728382
Name:HOLOCKER, DENISE (PA)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:HOLOCKER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:
Other - Last Name:REZEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29160 CENTER RIDGE RD
Mailing Address - Street 2:STE C
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5225
Mailing Address - Country:US
Mailing Address - Phone:440-617-1823
Mailing Address - Fax:440-617-0884
Practice Address - Street 1:15900 SNOW RD
Practice Address - Street 2:STE 200
Practice Address - City:BROOKPARK
Practice Address - State:OH
Practice Address - Zip Code:44142
Practice Address - Country:US
Practice Address - Phone:216-676-1234
Practice Address - Fax:216-676-5876
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50002323363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHREPA25712Medicare PIN
OHQ54348Medicare UPIN