Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1124469994 |
---|---|
Provider Name | Ms. Jeannette Holmes |
First Address | Clinton, NC 28328-9324 |
Second Address | Clinton, NC 28328-9324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2013 |
Last Update Date | 09/07/2013 |