Henrick Karl Holmberg, RN

Primary specialty

Administrator Registered NurseTaxonomy code 163WA2000X

License

RN198338 Issued in AZ

Practice address

Corner of NR 7 & NR 12
Fort Defiance, AZ 86504

Phone

(928) 729-8581

NPI assigned

Oct 27, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fort Defiance Indian Hospital Board, Inc

  • Rural Acute Care Hospital
  • Fort Defiance, AZ
  • NPI 1366993636
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1635292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635292800000",
    "number": "1598429300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 649",
            "city": "FORT DEFIANCE",
            "state": "AZ",
            "postal_code": "865040649",
            "telephone_number": "928-729-8581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CORNER OF NR 7 & NR 12",
            "city": "FORT DEFIANCE",
            "state": "AZ",
            "postal_code": "86504",
            "telephone_number": "928-729-8581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLMBERG",
        "first_name": "HENRICK",
        "middle_name": "KARL",
        "name_prefix": "Mr.",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-10-27",
        "last_updated": "2021-10-27",
        "certification_date": "2021-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "AL",
            "license": "1-138207",
            "primary": false
        },
        {
            "code": "163WA2000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Administrator",
            "state": "AZ",
            "license": "RN198338",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "fdihb.org",
            "affiliation": "Y",
            "affiliationName": "Fort Defiance Indian Hospital Board, Inc",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "Corner of Route N12 and N7",
            "address_2": "Fort Defiance Indian Hospital Board, Inc",
            "city": "Fort Defiance",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "865040589",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Amber Heym, MD
• Tonda Hill, M.D.
• Mary Hoft, DNP, PMHNP
• Tyler Carty Holland
• Cheryl Garrett Holmberg, RN, ACM
• Gary Ray Horn II, RN
• Sherry Hou, PHARMD
• Hozho Nahasdlii Health Care at Home
• Jennifer Lee Hubbard, M.D.
• Julie Denise Hughes, CRNA

• Administrator Registered Nurse in Fort Defiance, AZ
• Providers in Fort Defiance, AZ by specialty
• Administrator Registered Nurse in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.