Provider Demographics
NPI:1821349150
Name:HOLMES, RENEE (LPN)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:TIFFANY-LUNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7222 SW SCHOLLS FERRY RD
Mailing Address - Street 2:APT 2
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-4067
Mailing Address - Country:US
Mailing Address - Phone:503-475-0242
Mailing Address - Fax:
Practice Address - Street 1:1121 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2043
Practice Address - Country:US
Practice Address - Phone:503-731-8620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201130152LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse