Provider Demographics
NPI:1891039889
Name:HOLMES, CYNTHIA (LPN)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13011 BANCROFT ST
Mailing Address - Street 2:
Mailing Address - City:SWANTON
Mailing Address - State:OH
Mailing Address - Zip Code:43558-9636
Mailing Address - Country:US
Mailing Address - Phone:567-686-3824
Mailing Address - Fax:
Practice Address - Street 1:13011 BANCROFT ST
Practice Address - Street 2:
Practice Address - City:SWANTON
Practice Address - State:OH
Practice Address - Zip Code:43558-9636
Practice Address - Country:US
Practice Address - Phone:567-686-3824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH149703164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH149703OtherOHIO BOARD OF NURSING