Provider Demographics
NPI:1831982644
Name:HOLMES, BERNADETTE (RN)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4768 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19137-2224
Mailing Address - Country:US
Mailing Address - Phone:267-616-9457
Mailing Address - Fax:
Practice Address - Street 1:10101 ACADEMY RD STE 101
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1120
Practice Address - Country:US
Practice Address - Phone:267-616-9457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-24
Last Update Date:2025-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA640218163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse