Provider Demographics
NPI:1326774258
Name:HOLDER, RAEANNE EILENE (NP)
Entity Type:Individual
Prefix:MRS
First Name:RAEANNE
Middle Name:EILENE
Last Name:HOLDER
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 1:40075 BOB HOPE DR STE A
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3945
Mailing Address - Country:US
Mailing Address - Phone:760-341-3688
Mailing Address - Fax:760-341-8992
Practice Address - Street 1:40075 BOB HOPE DR STE A
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3945
Practice Address - Country:US
Practice Address - Phone:760-341-3688
Practice Address - Fax:760-341-8992
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021563363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily