Individual
MELISSA HOLMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RSA
Contact information
Practice address
19015 S JODI RD STE H, MOKENA, IL 60448-8534
(708) 995-5418
(832) 804-8886
Mailing address
19015 S JODI RD STE H, MOKENA, IL 60448-8534
(708) 995-5418
(832) 804-8886
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SA.0003122
COLORADO DEPARTMENT OF REGULATORY AGENCIES
CO
Enumeration date
12/07/2023
Last updated
12/07/2023
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