MEDICARE: RANISHA HOLMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor	NONE	NV

General Provider Information

NPI Number	:	1770943334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANISHA HOLMAN

Provider Business Mailing Address
First Line	:	8128 AUTUMN STAR AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-2433
Country	:	US
Telephone Number	:	310-220-7199
Fax Number	:

Provider Business Practice Location Address
First Line	:	8128 AUTUMN STAR AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-2433
Country	:	US
Telephone Number	:	310-220-7199
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2016
Last Update Date	:	02/25/2016

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Directions to “ RANISHA HOLMAN ” Practice Location

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