Provider Demographics
NPI:1881745081
Name:HOLMAN, SHANA M (PA-C)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:M
Last Name:HOLMAN
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:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:702-838-8265
Mailing Address - Fax:702-363-8753
Practice Address - Street 1:2716 N TENAYA WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0424
Practice Address - Country:US
Practice Address - Phone:702-243-8500
Practice Address - Fax:702-363-8753
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA662363AM0700X
NVPA1018363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV108405OtherSMACC MEDICARE
NVPA1018OtherNEVADA PA LICENSE
ALPA662OtherSTATE LICENSE
AL650622859OtherTAX ID
AL116033Medicaid
NV1881745081OtherMEDICAID - SMA
NV880400682OtherTAX ID NUMBER
NVV108405OtherSMACC MEDICARE
AL116033Medicaid