Provider Demographics
NPI:1336859990
Name:HOLT, SHANA R
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:R
Last Name:HOLT
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 1:4423 DANIELS CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:TX
Mailing Address - Zip Code:75570-6352
Mailing Address - Country:US
Mailing Address - Phone:903-278-8326
Mailing Address - Fax:
Practice Address - Street 1:4423 DANIELS CHAPEL RD
Practice Address - Street 2:
Practice Address - City:NEW BOSTON
Practice Address - State:TX
Practice Address - Zip Code:75570-6352
Practice Address - Country:US
Practice Address - Phone:903-278-8326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX719884163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse