Provider Demographics
NPI:1902165822
Name:HOLMES, DORIAN RENEE (ND)
Entity Type:Individual
Prefix:DR
First Name:DORIAN
Middle Name:RENEE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 7TH ST # 381
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-2605
Mailing Address - Country:US
Mailing Address - Phone:425-780-5374
Mailing Address - Fax:
Practice Address - Street 1:11753 LAKESIDE AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-5948
Practice Address - Country:US
Practice Address - Phone:425-780-5374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-12
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60250685175F00000X
CAND-580175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath