Provider Demographics
NPI:1558881748
Name:HOLMES, TANEISHA (CNA)
Entity Type:Individual
Prefix:
First Name:TANEISHA
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1056 N BOXWOOD DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-1204
Mailing Address - Country:US
Mailing Address - Phone:847-346-2263
Mailing Address - Fax:
Practice Address - Street 1:1056 N BOXWOOD DR UNIT A
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-1204
Practice Address - Country:US
Practice Address - Phone:847-346-2263
Practice Address - Fax:847-346-2263
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide