Provider Demographics
NPI:1154149300
Name:HOLMES, ALTHEA (RN)
Entity type:Individual
Prefix:
First Name:ALTHEA
Middle Name:
Last Name:HOLMES
Suffix:
Gender:U
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 SKY HIGH RD
Mailing Address - Street 2:
Mailing Address - City:LA FAYETTE
Mailing Address - State:NY
Mailing Address - Zip Code:13084-3322
Mailing Address - Country:US
Mailing Address - Phone:315-396-1204
Mailing Address - Fax:
Practice Address - Street 1:520 CEDAR ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2302
Practice Address - Country:US
Practice Address - Phone:315-396-1204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-27
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY815357163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse