Healthcare Provider Details

I. General information

NPI: 1205384344
Provider Name (Legal Business Name): LORIA HOLMES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 09/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 GRANADA DR 2D
JACKSON MI
49202-1309
US

IV. Provider business mailing address

2720 GRANADA DR 2D
JACKSON MI
49202-1309
US

V. Phone/Fax

Practice location:
  • Phone: 517-945-6947
  • Fax:
Mailing address:
  • Phone: 517-945-6947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: