Provider Demographics
NPI:1750013850
Name:HOLDEN, NERISSA A (COSMETOLOGIST)
Entity Type:Individual
Prefix:
First Name:NERISSA
Middle Name:A
Last Name:HOLDEN
Suffix:
Gender:F
Credentials:COSMETOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7604 CEDAR TREE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-1246
Mailing Address - Country:US
Mailing Address - Phone:704-777-7292
Mailing Address - Fax:980-236-8209
Practice Address - Street 1:1126 SAM NEWELL RD STE D4
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5083
Practice Address - Country:US
Practice Address - Phone:704-777-7292
Practice Address - Fax:980-236-8209
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2022-11-01
Deactivation Date:2022-10-27
Deactivation Code:
Reactivation Date:2022-11-01
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Yes335E00000XSuppliersProsthetic/Orthotic Supplier