Provider Demographics
NPI:1720538119
Name:HOLNESS, LUEDENI TILIA
Entity Type:Individual
Prefix:MRS
First Name:LUEDENI
Middle Name:TILIA
Last Name:HOLNESS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 NEW JERSEY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-4111
Mailing Address - Country:US
Mailing Address - Phone:917-975-9910
Mailing Address - Fax:
Practice Address - Street 1:412 NEW JERSEY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-4111
Practice Address - Country:US
Practice Address - Phone:917-975-9910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1359595390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program