Provider Demographics
NPI:1760682397
Name:HOLNAIDER, MARIANN (PA-C)
Entity type:Individual
Prefix:
First Name:MARIANN
Middle Name:
Last Name:HOLNAIDER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2321 RAYMOND AVE
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-3347
Mailing Address - Country:US
Mailing Address - Phone:724-537-2606
Mailing Address - Fax:
Practice Address - Street 1:2321 RAYMOND AVE
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-3347
Practice Address - Country:US
Practice Address - Phone:724-537-2606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-22
Last Update Date:2011-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013025-1363A00000X
PA055431146L00000X
OH0101920146L00000X
PAMA052971363AM0700X
PAMSG001428225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist