Provider Demographics
NPI:1619075959
Name:HOLTMAN, DEANNA MOORE (NP)
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:MOORE
Last Name:HOLTMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1001 W FAYETTE ST STE 400
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-2866
Mailing Address - Country:US
Mailing Address - Phone:315-937-3433
Mailing Address - Fax:315-464-6238
Practice Address - Street 1:739 IRVING AVE STE 450
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1663
Practice Address - Country:US
Practice Address - Phone:315-470-7364
Practice Address - Fax:315-378-0828
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY288542-1163WG0000X
NY333728363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice