MEDICARE: ALICIA HOLMES RN

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	163W00000X	Registered Nurse	390654	NY

General Provider Information

NPI Number	:	1790128692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA HOLMES RN

Provider Business Mailing Address
First Line	:	1517 PARK PL
Second Line	:	20R
City	:	BROOKLYN
State	:	NY
Zip	:	11213-3153
Country	:	US
Telephone Number	:	206-426-6196
Fax Number	:

Provider Business Practice Location Address
First Line	:	1517 PARK PL
Second Line	:	20R
City	:	BROOKLYN
State	:	NY
Zip	:	11213-3153
Country	:	US
Telephone Number	:	206-426-6196
Fax Number	:

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

Provider Enumeration Date	:	04/10/2013
Last Update Date	:	04/10/2013

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