Provider Demographics
NPI:1689008641
Name:HOLMES, JENNIFER LYNN (RN)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYNN
Last Name:HOLMES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:JENNFER
Other - Middle Name:LYNN
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:153 5TH AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-1014
Mailing Address - Country:US
Mailing Address - Phone:518-364-0007
Mailing Address - Fax:
Practice Address - Street 1:153 5TH AVE
Practice Address - Street 2:APT 1
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-1014
Practice Address - Country:US
Practice Address - Phone:518-364-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22617752163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical