Provider Demographics
NPI:1336135227
Name:HOLT, DORENE K (RN, BC)
Entity Type:Individual
Prefix:MS
First Name:DORENE
Middle Name:K
Last Name:HOLT
Suffix:
Gender:F
Credentials:RN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4390 S DAYTON BRANDT RD
Mailing Address - Street 2:
Mailing Address - City:NEW CARLISLE
Mailing Address - State:OH
Mailing Address - Zip Code:45344-9698
Mailing Address - Country:US
Mailing Address - Phone:937-845-9712
Mailing Address - Fax:937-845-9712
Practice Address - Street 1:4881 SUGAR MAPLE DR
Practice Address - Street 2:88MDOS/SGOCP
Practice Address - City:WPAFB
Practice Address - State:OH
Practice Address - Zip Code:45433-5529
Practice Address - Country:US
Practice Address - Phone:937-522-4732
Practice Address - Fax:937-656-1301
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN197762163WC1500X, 163WL0100X, 163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant