Provider Demographics
NPI:1649060203
Name:HOLMES, WAYLAND ANTHONY
Entity type:Individual
Prefix:MR
First Name:WAYLAND
Middle Name:ANTHONY
Last Name:HOLMES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12123 EMMET ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-4264
Mailing Address - Country:US
Mailing Address - Phone:531-375-5638
Mailing Address - Fax:
Practice Address - Street 1:11714 SPRAGUE CIR # A
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-2253
Practice Address - Country:US
Practice Address - Phone:402-871-1929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor