Individual
SANDRA HOLT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
593 EDDY ST, CLAVERICK 2, PROVIDENCE, RI 02903-4923
(401) 854-2504
(401) 854-2519
Mailing address
PO BOX 9484, PROVIDENCE, RI 02940-9484
(401) 854-2500
(401) 854-2519
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN35082
RI
363LP0200X
Pediatric Nurse Practitioner
Primary
APRN00885
RI
363LP0200X
Pediatric Nurse Practitioner
NPP37390
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007058932
MEDICARE
RI
05
—
0710890
—
MA
01
—
12/14/2006
NHPRI
RI
01
—
1689756454
NPI
RI
01
—
30578-7
BLUECHIP
RI
01
—
413721
BCBSRI
RI
05
—
7058932
—
RI
01
—
939025129
RI MEDICARE GROUP NUMBER
RI
Enumeration date
10/20/2006
Last updated
08/27/2018
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