Provider Demographics
NPI:1972828457
Name:HOLMAN, LAURENCE SIDNEY (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:LAURENCE
Middle Name:SIDNEY
Last Name:HOLMAN
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 WAKE FOREST RD
Mailing Address - Street 2:STE 210
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6864
Mailing Address - Country:US
Mailing Address - Phone:919-787-7246
Mailing Address - Fax:919-787-7247
Practice Address - Street 1:10880 DURANT RD STE 324
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6629
Practice Address - Country:US
Practice Address - Phone:919-787-7246
Practice Address - Fax:919-787-7247
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003291A363LF0000X
INF1109060363LF0000X
NC5006588208VP0000X, 363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201189380Medicaid
IN201189380Medicaid