Provider Demographics
NPI:1508985292
Name:HOLMES, CYNTHIA L (FNP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:HOLMES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301C US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9701
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:193 MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:NORWAY
Practice Address - State:ME
Practice Address - Zip Code:04268-5645
Practice Address - Country:US
Practice Address - Phone:207-743-9292
Practice Address - Fax:207-743-1578
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP081075363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30010908Medicaid
ME277690099Medicaid
MEP00971145Medicare PIN
NH30010908Medicaid
ME277690099Medicaid
MENP355701Medicare PIN