Basic Information
| Provider Information | |||||||||
| NPI: | 1902235088 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLMAN | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 940 AVENUE 64 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911052711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232542274 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 940 AVENUE 64 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232542274 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2013 | ||||||||
| LastUpdateDate: | 11/08/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 243866 | CA | N | Nursing Service Providers | Licensed Practical Nurse | 164X00000X | 243866 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.