Healthcare Provider Details

I. General information

NPI: 1952771164
Provider Name (Legal Business Name): BRITTANY HOLMAN AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRITTANY BAKAL

II. Dates (important events)

Enumeration Date: 09/30/2015
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N MAIN ST
WARSAW NY
14569
US

IV. Provider business mailing address

2483 PRATT RD
CORFU NY
14036-9644
US

V. Phone/Fax

Practice location:
  • Phone: 716-239-9207
  • Fax:
Mailing address:
  • Phone: 716-239-9207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number7062901
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF309259-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: