Individual
CLARISSA HOLMES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
43 ROSE LN, MEDFORD, NY 11763-1329
(631) 897-2549
Mailing address
43 ROSE LN, MEDFORD, NY 11763-1329
(631) 897-2549
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
665061
NY
Other
Enumeration date
01/08/2013
Last updated
01/08/2013
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