Provider Demographics
NPI:1235484882
Name:HOLIMAN, JENNIFER JUNKO (RN/CNP, PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:JUNKO
Last Name:HOLIMAN
Suffix:
Gender:F
Credentials:RN/CNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 MILL ST
Mailing Address - Street 2:MAILSTOP 234
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-1048
Mailing Address - Country:US
Mailing Address - Phone:617-855-2305
Mailing Address - Fax:
Practice Address - Street 1:115 MILL ST
Practice Address - Street 2:MAILSTOP 234
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478
Practice Address - Country:US
Practice Address - Phone:617-855-2305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2274887163W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse