Individual
AMANDA HOLMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C, MSN, RN
Contact information
Practice address
800 GRAND CENTRAL MALL, SUITE 4, VIENNA, WV 26105-4100
(304) 485-3300
(304) 485-6489
Mailing address
800 GRAND CENTRAL MALL, SUITE 4, VIENNA, WV 26105-4100
(304) 485-3300
(304) 485-6489
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
303540
OH
163W00000X
Registered Nurse
62564
WV
363LF0000X
Family Nurse Practitioner
Primary
62564
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0142450
—
OH
05
—
3810029780
—
WV
Enumeration date
07/30/2015
Last updated
11/03/2015
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