Individual
MARY R. HOLT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
935 BAXTER ST SE, GRAND RAPIDS, MI 49506-2500
(616) 456-5310
(616) 456-8640
Mailing address
935 BAXTER ST SE, GRAND RAPIDS, MI 49506-2599
(616) 456-5310
(616) 456-8640
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
4704109296
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2742857
—
MI
Enumeration date
06/05/2008
Last updated
06/05/2008
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