MEDICARE: MRS. TIMBOLIN DEIRDRE HOLMES MSN,RN, APN,CNP

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	363LA2100X	Acute Care Nurse Practitioner	209.009027	IL

General Provider Information

NPI Number	:	1275814709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TIMBOLIN DEIRDRE HOLMES MSN,RN, APN,CNP

Provider Business Mailing Address
First Line	:	1147 S WABASH AVE STE 250B
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-2355
Country	:	US
Telephone Number	:	312-987-4878
Fax Number	:	312-235-0909

Provider Business Practice Location Address
First Line	:	1147 S WABASH AVE STE 250B
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-2355
Country	:	US
Telephone Number	:	312-987-4878
Fax Number	:	312-235-0909

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

Provider Enumeration Date	:	08/29/2011
Last Update Date	:	09/18/2022

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