Provider Demographics
NPI:1487940854
Name:HOLNESS, MAIMUNA MARTHA (CARE COORDINATOR)
Entity type:Individual
Prefix:MRS
First Name:MAIMUNA
Middle Name:MARTHA
Last Name:HOLNESS
Suffix:
Gender:F
Credentials:CARE COORDINATOR
Other - Prefix:
Other - First Name:DIVINE
Other - Middle Name:
Other - Last Name:SHOWERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 110004
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99511-0004
Mailing Address - Country:US
Mailing Address - Phone:907-830-0686
Mailing Address - Fax:
Practice Address - Street 1:3801 BOEK CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-3059
Practice Address - Country:US
Practice Address - Phone:907-339-1589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK952509171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator