MEDICARE: CAMILLE NICOLE HOLMAN

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1770331449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMILLE NICOLE HOLMAN

Provider Business Mailing Address
First Line	:	8810 CHRISTYGATE LN
Second Line	:
City	:	HUBER HEIGHTS
State	:	OH
Zip	:	45424-6423
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8810 CHRISTYGATE LN
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45424-6423
Country	:	US
Telephone Number	:	937-718-8279
Fax Number	:

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

Provider Enumeration Date	:	05/08/2024
Last Update Date	:	06/09/2024

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Directions to “ CAMILLE NICOLE HOLMAN ” Practice Location

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