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General NPI Number Information
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NPI Number | 1104537687
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Entity Type | Individual
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Provider Name | EVERETT L HOLMES
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Gender | Male
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Dates
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Enumeration Date | 12/06/2022
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Last Update Date | 12/06/2022
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Provider Practice Location Address
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Address Line | 1100 ESSINGTON RD STE 5
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City | JOLIET
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State | IL
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Zip | 60435-8418
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Country | US
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Telephone | 815-725-8522
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Fax |
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Provider Business Mailing Address
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Address Line | 304 N KNOX ST
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City | PRINCETON
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State | IL
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Zip | 61356-1660
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Country | US
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Telephone | 815-725-8522
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 2866
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License Number State | IL
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