Healthcare Provider Details

I. General information

NPI: 1477951440
Provider Name (Legal Business Name): DIONNE HOLT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2014
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 LOCUST AVE
MOUNTAINSIDE NJ
07092-2607
US

IV. Provider business mailing address

173 LOCUST AVE
MOUNTAINSIDE NJ
07092-2607
US

V. Phone/Fax

Practice location:
  • Phone: 908-251-1644
  • Fax:
Mailing address:
  • Phone: 908-251-1644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00542800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NO11830000
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ00542800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: