Provider Demographics
NPI:1841027406
Name:HOLMES, MARTA (PNP)
Entity type:Individual
Prefix:
First Name:MARTA
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 WYCOMB PL
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-1043
Mailing Address - Country:US
Mailing Address - Phone:631-835-3431
Mailing Address - Fax:
Practice Address - Street 1:239 BOYLE RD
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-1955
Practice Address - Country:US
Practice Address - Phone:631-698-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY383706363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics