Provider Demographics
NPI:1801416698
Name:HOLSINGER, DESIREA RAECHELLE
Entity Type:Individual
Prefix:
First Name:DESIREA
Middle Name:RAECHELLE
Last Name:HOLSINGER
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 1:6020 BLUE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:STOUT
Mailing Address - State:OH
Mailing Address - Zip Code:45684-9631
Mailing Address - Country:US
Mailing Address - Phone:937-217-4116
Mailing Address - Fax:
Practice Address - Street 1:6020 BLUE CREEK RD
Practice Address - Street 2:
Practice Address - City:STOUT
Practice Address - State:OH
Practice Address - Zip Code:45684-9631
Practice Address - Country:US
Practice Address - Phone:937-217-4116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide