Healthcare Provider Details

I. General information

NPI: 1689081440
Provider Name (Legal Business Name): DIANN HOLMES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2014
Last Update Date: 07/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 S BROADWAY
CAMDEN NJ
08103-1209
US

IV. Provider business mailing address

317 S BROADWAY
CAMDEN NJ
08103-1209
US

V. Phone/Fax

Practice location:
  • Phone: 856-365-3519
  • Fax:
Mailing address:
  • Phone: 856-365-3519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NO08354500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: