Healthcare Provider Details

I. General information

NPI: 1972126027
Provider Name (Legal Business Name): VICTORIA HOLMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2020
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 WAREHAM RD
MARION MA
02738-1175
US

IV. Provider business mailing address

240 WAREHAM RD
MARION MA
02738-1175
US

V. Phone/Fax

Practice location:
  • Phone: 508-748-1313
  • Fax: 508-748-2590
Mailing address:
  • Phone: 508-748-1313
  • Fax: 508-748-2590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2330266
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: