Basic Information
| Provider Information | |||||||||
| NPI: | 1568598266 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLQUIST | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4324 PLEASANT PATH | ||||||||
| Address2: | |||||||||
| City: | ELLICOTT CITY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104611451 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7600 CARROLL AVE | ||||||||
| Address2: | WASHINGTON ADVENTIST HOSPITAL | ||||||||
| City: | TAKOMA PARK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018917600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | R128062 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.