Healthcare Provider Details

I. General information

NPI: 1073025904
Provider Name (Legal Business Name): MRS. TIAWANA MICHELLE HOLMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2017
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3234 13TH ST SE APT 102
WASHINGTON DC
20032-4529
US

IV. Provider business mailing address

5850 SOUTHERN AVE SE
WASHINGTON DC
20019-6552
US

V. Phone/Fax

Practice location:
  • Phone: 202-827-9004
  • Fax:
Mailing address:
  • Phone: 202-912-0239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: