Provider Demographics
NPI:1578788204
Name:HOLMAN, ANTOINETTE JUNE (LPN)
Entity Type:Individual
Prefix:MS
First Name:ANTOINETTE
Middle Name:JUNE
Last Name:HOLMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 E BEL AIR AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001-3796
Mailing Address - Country:US
Mailing Address - Phone:646-271-8383
Mailing Address - Fax:
Practice Address - Street 1:RIVERVIEW CENTER 150 BROADWAY
Practice Address - Street 2:SUITE 6E
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12204
Practice Address - Country:US
Practice Address - Phone:800-343-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228546164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02570047Medicaid