Provider Demographics
NPI:1558794040
Name:HOLT, VALERIE RENEE (NP)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:RENEE
Last Name:HOLT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:RENEE
Other - Last Name:NYDAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1 GENERAL STREET
Mailing Address - Street 2:HOSPITAL MEDICINE
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841
Mailing Address - Country:US
Mailing Address - Phone:781-744-3839
Mailing Address - Fax:781-744-1597
Practice Address - Street 1:1 GENERAL STREET
Practice Address - Street 2:HOSPITAL MEDICINE
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841
Practice Address - Country:US
Practice Address - Phone:781-744-3839
Practice Address - Fax:781-744-1597
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2261962163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse