Nicole Holmberg, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

097600 Issued in IA

Practice address

3209 Ingersoll Ave Ste 100
Des Moines, IA 50312-3920

Phone

(515) 444-0480

NPI assigned

Aug 12, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 29, 2024 through Jan 29, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

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.

• Birchwood Wellness

  • Multi-Specialty Clinic/Center
  • Ankeny, IA
  • NPI 1124405055
  NPD (past)

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

{
    "created_epoch": "1565568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646006400000",
    "number": "1922654375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3209 INGERSOLL AVE STE 100",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503123920",
            "telephone_number": "515-444-0480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3209 INGERSOLL AVE STE 100",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503123920",
            "telephone_number": "515-444-0480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLMBERG",
        "first_name": "NICOLE",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-08-12",
        "last_updated": "2022-02-28",
        "certification_date": "2022-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IA",
            "license": "097600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cara Elizabeth Hollmer, DO
• Veronica Holloway, PMHNP-BC
• Eric J Holm, MD
• Lydia J Holm, MD
• Talana Jo Holman
• Aaron Holmes, DO
• Angela Maria Holmes, PHARM.D.
• Brianne Leigh Holmes, R.D.
• Joshua Holsing, MD
• Ellicia Holst

• Clinical Psychologist in Des Moines, IA
• Providers in Des Moines, IA by specialty
• Clinical Psychologist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.