Provider Demographics
NPI:1679061527
Name:HOLMES, REBECCA CAROL (MPA)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:CAROL
Last Name:HOLMES
Suffix:
Gender:F
Credentials:MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 NW WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-6688
Mailing Address - Country:US
Mailing Address - Phone:404-247-0539
Mailing Address - Fax:
Practice Address - Street 1:1925 NW WOODLAND DR
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-6688
Practice Address - Country:US
Practice Address - Phone:404-247-0539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program