MEDICARE: CARNYCIA DANIELLE HOLLIMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula

General Provider Information

NPI Number	:	1013676287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARNYCIA DANIELLE HOLLIMAN

Provider Business Mailing Address
First Line	:	4123 FLAD AVE APT A
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-3918
Country	:	US
Telephone Number	:	314-267-1513
Fax Number	:

Provider Business Practice Location Address
First Line	:	4123 FLAD AVE APT A
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-3918
Country	:	US
Telephone Number	:	314-267-1513
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2021
Last Update Date	:	12/14/2021

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