Provider Demographics
NPI:1508523192
Name:HOLDER, DENA-MARIE D
Entity Type:Individual
Prefix:
First Name:DENA-MARIE
Middle Name:D
Last Name:HOLDER
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 1:21 N CENTRAL ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-1748
Mailing Address - Country:US
Mailing Address - Phone:781-267-0330
Mailing Address - Fax:
Practice Address - Street 1:21 N CENTRAL ST UNIT B
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-1748
Practice Address - Country:US
Practice Address - Phone:781-267-0330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2276284163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse