Provider Demographics
NPI:1356465694
Name:HOLLIDAY, LYNDA (RN-BC)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:
Last Name:HOLLIDAY
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:PO BOX 568
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87504-0568
Mailing Address - Country:US
Mailing Address - Phone:505-982-8314
Mailing Address - Fax:
Practice Address - Street 1:542 JUNIPER DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-1692
Practice Address - Country:US
Practice Address - Phone:505-982-8314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR172322081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine