Provider Demographics
NPI:1831603414
Name:HOLDER, DONNA MICHELLE
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:MICHELLE
Last Name:HOLDER
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 1:195 SMITHSON LN
Mailing Address - Street 2:
Mailing Address - City:BUNCOMBE
Mailing Address - State:IL
Mailing Address - Zip Code:62912-2429
Mailing Address - Country:US
Mailing Address - Phone:618-697-6274
Mailing Address - Fax:
Practice Address - Street 1:195 SMITHSON LN
Practice Address - Street 2:
Practice Address - City:BUNCOMBE
Practice Address - State:IL
Practice Address - Zip Code:62912-2429
Practice Address - Country:US
Practice Address - Phone:618-697-6274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-19
Last Update Date:2017-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health