Provider Demographics
NPI:1528034097
Name:HOLMES, BETTY J (CRNA)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:J
Last Name:HOLMES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18577 PETTYJOHN RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-5205
Mailing Address - Country:US
Mailing Address - Phone:302-542-4048
Mailing Address - Fax:
Practice Address - Street 1:640 S STATE ST
Practice Address - Street 2:BAYHEALTH MEDICAL CENTER/DEPT. OF ANESTHESIA
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-3530
Practice Address - Country:US
Practice Address - Phone:302-744-7093
Practice Address - Fax:302-735-3239
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL60A00354367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEGR019630Medicaid
564307Medicare UPIN
010621K95Medicare ID - Type Unspecified