Provider Demographics
NPI:1841469301
Name:HOLMES, LAURA LEE (PA-C)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:LEE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 VIA VENADO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-6727
Mailing Address - Country:US
Mailing Address - Phone:505-310-1483
Mailing Address - Fax:505-983-5202
Practice Address - Street 1:435 SAINT MICHAELS DR STE A202
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7644
Practice Address - Country:US
Practice Address - Phone:505-983-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2008-006363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical