Provider Demographics
NPI:1295846749
Name:HOLMES, STEPHANIE L (NP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:HOLMES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 2700
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2653
Mailing Address - Country:US
Mailing Address - Phone:207-721-8700
Mailing Address - Fax:207-721-8715
Practice Address - Street 1:121 MEDICAL CENTER DRIVE
Practice Address - Street 2:SUITE 2700
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011
Practice Address - Country:US
Practice Address - Phone:207-721-8700
Practice Address - Fax:207-721-8715
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER025602363L00000X
MERO25602ANP:APO81362363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MES32225Medicare UPIN
VX3506Medicare PIN
S2225Medicare UPIN