Provider Demographics
NPI:1427792514
Name:HOLMES, CAITLIN (CNS)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 COLUMBIA ST UNIT C
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4221
Mailing Address - Country:US
Mailing Address - Phone:603-318-5527
Mailing Address - Fax:
Practice Address - Street 1:831 COLUMBIA ST UNIT C
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4221
Practice Address - Country:US
Practice Address - Phone:603-318-5527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLN-1462133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist