Provider Demographics
NPI:1396270013
Name:REID-HOLMES, DEVERY DANIELLE
Entity type:Individual
Prefix:
First Name:DEVERY
Middle Name:DANIELLE
Last Name:REID-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 1:102 ROXBOROUGH RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14619-1418
Mailing Address - Country:US
Mailing Address - Phone:585-957-5407
Mailing Address - Fax:
Practice Address - Street 1:102 ROXBOROUGH RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14619-1418
Practice Address - Country:US
Practice Address - Phone:585-957-5407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY326304-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse