Provider Demographics
NPI:1194184739
Name:HOLDER, LORNA ELSA (PMHNP)
Entity Type:Individual
Prefix:MS
First Name:LORNA
Middle Name:ELSA
Last Name:HOLDER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MACDONOUGH ST
Mailing Address - Street 2:12B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-2329
Mailing Address - Country:US
Mailing Address - Phone:347-525-4081
Mailing Address - Fax:
Practice Address - Street 1:25 MACDONOUGH ST
Practice Address - Street 2:12B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-2329
Practice Address - Country:US
Practice Address - Phone:347-525-4081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401945363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health