Healthcare Provider Details

I. General information

NPI: 1033489638
Provider Name (Legal Business Name): MRS. KELI-SUE HOLSONBACK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2012
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 WILSHIRE DR
GREENVILLE SC
29609-3830
US

IV. Provider business mailing address

11 WILSHIRE DR
GREENVILLE SC
29609-3830
US

V. Phone/Fax

Practice location:
  • Phone: 512-299-0340
  • Fax:
Mailing address:
  • Phone: 512-299-0340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: