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NPI Code Detail

MEDICARE: MR. KEITH FRANCIS HOLLIDAY R.N.

MEDICARE: MR. KEITH FRANCIS HOLLIDAY R.N.
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
1163W00000XRegistered Nurse0001171808VA

General Provider Information

NPI Number : 1821130378
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KEITH FRANCIS HOLLIDAY R.N.
Provider Business Mailing Address
First Line : 125 SEURAT LN
Second Line :
City : MARTINSBURG
State : WV
Zip : 25401-7683
Country : US
Telephone Number : 304-262-2559
Fax Number :
Provider Business Practice Location Address
First Line : 1434 PORTER ST
Second Line :
City : FREDERICK
State : MD
Zip : 21702-9210
Country : US
Telephone Number : 301-619-0345
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2007
Last Update Date : 07/08/2007

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