Provider Demographics
NPI:1487980108
Name:HOLMES, DONNA ZENOBIA (LM, CPM)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:ZENOBIA
Last Name:HOLMES
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1935 W BOULDER BAR DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-5944
Mailing Address - Country:US
Mailing Address - Phone:208-965-9125
Mailing Address - Fax:877-203-1886
Practice Address - Street 1:1935 W BOULDER BAR DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646
Practice Address - Country:US
Practice Address - Phone:208-965-9125
Practice Address - Fax:877-203-1886
Is Sole Proprietor?:No
Enumeration Date:2009-10-30
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL231176B00000X
FL09100004176B00000X
IDMID-32176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife