Provider Demographics
NPI:1619376662
Name:HOLMES, LYNDSIE NICOLE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:LYNDSIE
Middle Name:NICOLE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MS
Other - First Name:LYNDSIE
Other - Middle Name:NICOLE
Other - Last Name:WILBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:1728 EAST STATE AVE NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506
Mailing Address - Country:US
Mailing Address - Phone:360-352-2488
Mailing Address - Fax:360-943-5156
Practice Address - Street 1:1728 EAST STATE AVE NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506
Practice Address - Country:US
Practice Address - Phone:360-352-2488
Practice Address - Fax:360-943-5156
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60400625225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist