Provider Demographics
NPI:1992065544
Name:HOLMES, RACHEL (CNA)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 W DAVENPORT ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-8137
Mailing Address - Country:US
Mailing Address - Phone:208-559-0482
Mailing Address - Fax:
Practice Address - Street 1:355 W DAVENPORT ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8137
Practice Address - Country:US
Practice Address - Phone:208-559-0482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDID000102321107376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide