Provider Demographics
NPI:1013042449
Name:HOLMAN, COLLEEN FARRELL (RN)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:FARRELL
Last Name:HOLMAN
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 1:12522 N 82ND DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-9017
Mailing Address - Country:US
Mailing Address - Phone:602-764-8021
Mailing Address - Fax:
Practice Address - Street 1:1900 W THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-6051
Practice Address - Country:US
Practice Address - Phone:602-764-8021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN060561163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse