Provider Demographics
NPI:1912395609
Name:HOLBROOKS, BELINDA (STNA)
Entity Type:Individual
Prefix:
First Name:BELINDA
Middle Name:
Last Name:HOLBROOKS
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 6TH ST
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT HARBOR
Mailing Address - State:OH
Mailing Address - Zip Code:44077-5650
Mailing Address - Country:US
Mailing Address - Phone:440-391-2774
Mailing Address - Fax:
Practice Address - Street 1:317 6TH ST
Practice Address - Street 2:
Practice Address - City:FAIRPORT HARBOR
Practice Address - State:OH
Practice Address - Zip Code:44077-5650
Practice Address - Country:US
Practice Address - Phone:440-391-2774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-02
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH369241521090376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0112959Medicaid