Healthcare Provider Details

I. General information

NPI: 1760682751
Provider Name (Legal Business Name): LA CARLA DENISE HOLMES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 05/31/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 SALINA ST
ROCHESTER NY
14619-1014
US

IV. Provider business mailing address

233 LAGRANGE AVE
ROCHESTER NY
14613-1562
US

V. Phone/Fax

Practice location:
  • Phone: 585-235-8556
  • Fax:
Mailing address:
  • Phone: 585-752-3127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number545922
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number403245
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: