Provider Demographics
NPI:1033489638
Name:HOLSONBACK, KELI-SUE
Entity Type:Individual
Prefix:MRS
First Name:KELI-SUE
Middle Name:
Last Name:HOLSONBACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 WILSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-3830
Mailing Address - Country:US
Mailing Address - Phone:512-299-0340
Mailing Address - Fax:
Practice Address - Street 1:11 WILSHIRE DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-3830
Practice Address - Country:US
Practice Address - Phone:512-299-0340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula