Provider Demographics
NPI:1497024764
Name:HOLDER, DONNA MARIE (RN)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:MARIE
Last Name:HOLDER
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 1:316 WEST MILLER STREET
Mailing Address - Street 2:N.R. KELLEY INTERMEDIATE SCHOOL
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-2099
Mailing Address - Country:US
Mailing Address - Phone:315-332-3339
Mailing Address - Fax:315-332-3624
Practice Address - Street 1:316 W MILLER ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1446
Practice Address - Country:US
Practice Address - Phone:315-332-3339
Practice Address - Fax:315-332-3624
Is Sole Proprietor?:No
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338677-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse