Provider Demographics
NPI:1093590580
Name:HOLMAN, TAYLER LYNDSEY (NP)
Entity Type:Individual
Prefix:
First Name:TAYLER
Middle Name:LYNDSEY
Last Name:HOLMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3428 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-4538
Mailing Address - Country:US
Mailing Address - Phone:509-552-6674
Mailing Address - Fax:
Practice Address - Street 1:3428 5TH ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-4538
Practice Address - Country:US
Practice Address - Phone:509-552-6674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61471050363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily