Provider Demographics
NPI:1902431729
Name:HOLMES, MIARI (LPN)
Entity Type:Individual
Prefix:
First Name:MIARI
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 SENECA MANOR DR APT D
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-5427
Mailing Address - Country:US
Mailing Address - Phone:585-485-9951
Mailing Address - Fax:
Practice Address - Street 1:47 SENECA MANOR DR APT D
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-5427
Practice Address - Country:US
Practice Address - Phone:585-485-9951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337930164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse