Provider Demographics
NPI:1215102736
Name:HOLMES, ALICIA DIANE (CPM)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:DIANE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 N STATE ROAD 15
Mailing Address - Street 2:
Mailing Address - City:WABASH
Mailing Address - State:IN
Mailing Address - Zip Code:46992-8398
Mailing Address - Country:US
Mailing Address - Phone:260-563-9213
Mailing Address - Fax:
Practice Address - Street 1:832 N STATE ROAD 15
Practice Address - Street 2:
Practice Address - City:WABASH
Practice Address - State:IN
Practice Address - Zip Code:46992-8398
Practice Address - Country:US
Practice Address - Phone:260-563-9213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife