Provider Demographics
NPI:1861651440
Name:HOLDEN, LOU ANN (NP)
Entity Type:Individual
Prefix:MRS
First Name:LOU ANN
Middle Name:
Last Name:HOLDEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 YORKTOWN RD
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-1213
Mailing Address - Country:US
Mailing Address - Phone:631-751-2400
Mailing Address - Fax:
Practice Address - Street 1:22 YORKTOWN RD
Practice Address - Street 2:
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-1213
Practice Address - Country:US
Practice Address - Phone:631-751-2171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302560282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital