Provider Demographics
NPI:1689335903
Name:HOLMAN, MARY A
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:HOLMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 BIRCHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-1332
Mailing Address - Country:US
Mailing Address - Phone:810-493-3193
Mailing Address - Fax:
Practice Address - Street 1:747 BIRCHWOOD DR
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-1332
Practice Address - Country:US
Practice Address - Phone:810-493-3193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-08
Last Update Date:2022-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide