Provider Demographics
NPI:1891245353
Name:HOLSTON, IRIS
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:HOLSTON
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 1:3530 MILLVALE AVE NE APT A
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44705-4976
Mailing Address - Country:US
Mailing Address - Phone:614-507-9405
Mailing Address - Fax:
Practice Address - Street 1:3530 MILLVALE AVE NE APT A
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44705-4976
Practice Address - Country:US
Practice Address - Phone:614-507-9405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-09
Last Update Date:2016-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide