Provider Demographics
NPI:1881022952
Name:HOLMES, TERESA
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:HOLMES
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 1:1465 GENEVA LOOP
Mailing Address - Street 2:APT 4C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11239-2420
Mailing Address - Country:US
Mailing Address - Phone:347-893-9593
Mailing Address - Fax:
Practice Address - Street 1:1465 GENEVA LOOP
Practice Address - Street 2:APT 4C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11239-2420
Practice Address - Country:US
Practice Address - Phone:347-893-9593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-28
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY266592164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse