Provider Demographics
NPI:1174609598
Name:HOLMES, ROXANNA (ARNP)
Entity type:Individual
Prefix:
First Name:ROXANNA
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3377 RIVERBEND DR
Mailing Address - Street 2:PEACEHEALTH URGENT CARE
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-8803
Mailing Address - Country:US
Mailing Address - Phone:541-222-6005
Mailing Address - Fax:541-222-6029
Practice Address - Street 1:3377 RIVERBEND DR
Practice Address - Street 2:PEACEHEALTH URGENT CARE
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-8803
Practice Address - Country:US
Practice Address - Phone:541-222-6005
Practice Address - Fax:541-222-6029
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP 304363L00000X
OR200850115NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002662100Medicaid
IDS44355Medicare UPIN
ID002662100Medicaid