Provider Demographics
NPI:1982915179
Name:HOLMAN, JENNIFER LEE NASH (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE NASH
Last Name:HOLMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WFSM DEPARTMENT OF PEDIATRICS
Mailing Address - Street 2:MEDICAL CENTER BOULEVARD
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-1081
Mailing Address - Country:US
Mailing Address - Phone:336-716-4663
Mailing Address - Fax:
Practice Address - Street 1:WFSM DEPARTMENT OF PEDIATRICS
Practice Address - Street 2:MEDICAL CENTER BOULEVARD
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-1081
Practice Address - Country:US
Practice Address - Phone:336-716-4663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC2013-010932080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program