Individual
IRENE BENALLY-HOLMES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
HIGHWAY 264 MILEPOST 388, POLSCCA, AZ 86042
(928) 737-6003
Mailing address
PO BOX 4000, POLACCA, AZ 86042-4000
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN169674
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020529
—
AZ
Enumeration date
10/06/2014
Last updated
10/06/2014
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