Provider Demographics
NPI:1952120123
Name:HOLEMAN, TERYN A (PHD MEDICAL STUDENT)
Entity type:Individual
Prefix:DR
First Name:TERYN
Middle Name:A
Last Name:HOLEMAN
Suffix:
Gender:F
Credentials:PHD MEDICAL STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1753 E BRYAN AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-2670
Mailing Address - Country:US
Mailing Address - Phone:520-780-8170
Mailing Address - Fax:
Practice Address - Street 1:1753 E BRYAN AVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-2670
Practice Address - Country:US
Practice Address - Phone:520-780-8170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-07
Last Update Date:2024-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program