Provider Demographics
NPI:1356691091
Name:HOLMAN, WHITNEY ALLISON (FNP)
Entity type:Individual
Prefix:MISS
First Name:WHITNEY
Middle Name:ALLISON
Last Name:HOLMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:ALLISON
Other - Last Name:KESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:15008 CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2184
Mailing Address - Country:US
Mailing Address - Phone:734-626-5690
Mailing Address - Fax:
Practice Address - Street 1:2333 BIDDLE AVE
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-4668
Practice Address - Country:US
Practice Address - Phone:313-982-8282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-10
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704259771163WI0500X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Multi-Specialty