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NPI Code Detail

MEDICARE: PATIENCE MARIE HOLDREN BCABA, LABA

MEDICARE: PATIENCE MARIE HOLDREN BCABA, LABA
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
1103K00000XBehavior Analyst0134000241VA

General Provider Information

NPI Number : 1043778822
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATIENCE MARIE HOLDREN BCABA, LABA
Provider Business Mailing Address
First Line : 5296 PETERS CREEK RD
Second Line :
City : ROANOKE
State : VA
Zip : 24019-3808
Country : US
Telephone Number : 540-553-6423
Fax Number : 540-206-2109
Provider Business Practice Location Address
First Line : 5296 PETERS CREEK RD
Second Line :
City : ROANOKE
State : VA
Zip : 24019-3808
Country : US
Telephone Number : 540-215-0535
Fax Number : 540-206-2109
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2019
Last Update Date : 11/08/2023

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