Provider Demographics
NPI:1093603490
Name:HOLMAN, GINA S
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:S
Last Name:HOLMAN
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 1:204 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:LA PORTE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50651-1309
Mailing Address - Country:US
Mailing Address - Phone:319-415-3804
Mailing Address - Fax:
Practice Address - Street 1:204 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LA PORTE CITY
Practice Address - State:IA
Practice Address - Zip Code:50651-1309
Practice Address - Country:US
Practice Address - Phone:319-415-3804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA098263163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse