Provider Demographics
NPI:1073547717
Name:HOLMAN, DEBBIE LYNN (APN)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:LYNN
Last Name:HOLMAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:IL
Mailing Address - Zip Code:62812-1918
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1403 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:IL
Practice Address - Zip Code:62812-1918
Practice Address - Country:US
Practice Address - Phone:618-923-4310
Practice Address - Fax:618-435-4310
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277000126363L00000X
IN71007716A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILQ15090Medicare UPIN
ILQ15090Medicare UPIN