Healthcare Provider Details

I. General information

NPI: 1720048705
Provider Name (Legal Business Name): DEBRA C HOLMES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DVAMC SURG 112 A5004 508 FULTON STREET
DURHAM NC
27705
US

IV. Provider business mailing address

DVAMC SURG 112 A5004 508 FULTON STREET
DURHAM NC
27705
US

V. Phone/Fax

Practice location:
  • Phone: 919-286-0411
  • Fax: 919-416-5857
Mailing address:
  • Phone: 919-286-0411
  • Fax: 919-416-5857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0101158
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: