Provider Demographics
NPI:1467152025
Name:HOLSTEIN, MARY ANN
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:HOLSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9948 BROUNLAND RD
Mailing Address - Street 2:
Mailing Address - City:ALUM CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:25003-5430
Mailing Address - Country:US
Mailing Address - Phone:304-533-6724
Mailing Address - Fax:
Practice Address - Street 1:9948 BROUNLAND RD
Practice Address - Street 2:
Practice Address - City:ALUM CREEK
Practice Address - State:WV
Practice Address - Zip Code:25003-5430
Practice Address - Country:US
Practice Address - Phone:304-533-6724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant