Provider Demographics
NPI:1285885665
Name:HOLIDAY, NICKI NICOLE (RN)
Entity type:Individual
Prefix:
First Name:NICKI
Middle Name:NICOLE
Last Name:HOLIDAY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5433 MELANITE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77053-3226
Mailing Address - Country:US
Mailing Address - Phone:281-438-9200
Mailing Address - Fax:281-439-9202
Practice Address - Street 1:5433 MELANITE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77053-3226
Practice Address - Country:US
Practice Address - Phone:281-438-9200
Practice Address - Fax:281-439-9202
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202076038163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX677902Medicare Oscar/Certification