Provider Demographics
NPI:1396759882
Name:HOLT, DONNA E (NP)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:E
Last Name:HOLT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5344 SACANDAGA RD
Mailing Address - Street 2:
Mailing Address - City:GALWAY
Mailing Address - State:NY
Mailing Address - Zip Code:12074-2422
Mailing Address - Country:US
Mailing Address - Phone:518-882-6955
Mailing Address - Fax:
Practice Address - Street 1:5344 SACANDAGA RD
Practice Address - Street 2:
Practice Address - City:GALWAY
Practice Address - State:NY
Practice Address - Zip Code:12074-2422
Practice Address - Country:US
Practice Address - Phone:518-882-6955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0454592303363L00000X
NY331054363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30340114Medicaid
NHNP1546Medicare ID - Type Unspecified
NH30340114Medicaid