Provider Demographics
NPI:1427666171
Name:MASON HOLMES, MARVITA M
Entity type:Individual
Prefix:
First Name:MARVITA
Middle Name:M
Last Name:MASON HOLMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3955 MARTHA AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-1295
Mailing Address - Country:US
Mailing Address - Phone:937-977-3739
Mailing Address - Fax:
Practice Address - Street 1:3955 MARTHA AVE APT 5
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43612-1295
Practice Address - Country:US
Practice Address - Phone:937-977-3739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide