Provider Demographics
NPI:1902327612
Name:HOLMES, LAURA JEANNE (BSN, RN, MSN AGNP-C)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:JEANNE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:BSN, RN, MSN AGNP-C
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:JEANNE
Other - Last Name:SANTOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, RN, MSN AGNP-C
Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:ELLISON 11
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2696
Mailing Address - Country:US
Mailing Address - Phone:617-726-2000
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT STREET
Practice Address - Street 2:ELLISON 11
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-726-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2261893363LA2200X, 363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology