Provider Demographics
NPI:1427015049
Name:HOLMES, SUE BAIRD (RN)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:BAIRD
Last Name:HOLMES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:S83W29575 SAXONY CT
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-9000
Mailing Address - Country:US
Mailing Address - Phone:262-363-5744
Mailing Address - Fax:
Practice Address - Street 1:S83W29575 SAXONY CT
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-9000
Practice Address - Country:US
Practice Address - Phone:262-363-5744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI86666-030163WH0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health