Provider Demographics
NPI:1932561693
Name:HOLMES, JOANNA SUNSHINE (LMT)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:SUNSHINE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 7TH ST
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-2255
Mailing Address - Country:US
Mailing Address - Phone:503-887-8237
Mailing Address - Fax:
Practice Address - Street 1:104 5TH ST
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-2058
Practice Address - Country:US
Practice Address - Phone:541-490-1444
Practice Address - Fax:541-805-7003
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17189171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor