Provider Demographics
NPI:1447484894
Name:HOLMES, DANNY LEN (LPN)
Entity type:Individual
Prefix:MR
First Name:DANNY
Middle Name:LEN
Last Name:HOLMES
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 281
Mailing Address - Street 2:289 COUNTY ROUTE #11
Mailing Address - City:GOUVERNEUR
Mailing Address - State:NY
Mailing Address - Zip Code:13642
Mailing Address - Country:US
Mailing Address - Phone:315-287-0171
Mailing Address - Fax:
Practice Address - Street 1:289 COUNTY ROUTE #11
Practice Address - Street 2:
Practice Address - City:GOUVERNEUR
Practice Address - State:NY
Practice Address - Zip Code:13642
Practice Address - Country:US
Practice Address - Phone:315-287-0171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY279687-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse