Provider Demographics
NPI:1962291716
Name:HOLMES, ALEXIS ROSE
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:ROSE
Last Name:HOLMES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4060 VINTON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-3863
Mailing Address - Country:US
Mailing Address - Phone:402-991-9880
Mailing Address - Fax:
Practice Address - Street 1:1100 MARSHALL AVE APT 2B
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-1425
Practice Address - Country:US
Practice Address - Phone:402-807-9993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide