Provider Demographics
NPI:1386117695
Name:HOLMES, MOLLY B (RN, BSN)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:B
Last Name:HOLMES
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:B
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5343 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-3657
Mailing Address - Country:US
Mailing Address - Phone:814-566-3411
Mailing Address - Fax:
Practice Address - Street 1:1493 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1047
Practice Address - Country:US
Practice Address - Phone:671-665-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2328819163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse