Provider Demographics
NPI:1669567608
Name:HOLMAN, MELISSA (CRNP)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:HOLMAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-2919
Mailing Address - Country:US
Mailing Address - Phone:334-793-3319
Mailing Address - Fax:334-793-2291
Practice Address - Street 1:207 HAVEN DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-2919
Practice Address - Country:US
Practice Address - Phone:334-793-3319
Practice Address - Fax:334-793-2291
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-079347163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP82902Medicare UPIN