Healthcare Provider Details

I. General information

NPI: 1518421510
Provider Name (Legal Business Name): RACHEL RENEE HOLMES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 PORTLAND AVE
ROCHESTER NY
14621-3065
US

IV. Provider business mailing address

1204 IMPERIAL DR
WEBSTER NY
14580-9533
US

V. Phone/Fax

Practice location:
  • Phone: 585-697-6411
  • Fax: 585-342-9166
Mailing address:
  • Phone: 585-643-9218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number337451
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: