Basic Information
| Provider Information | |||||||||
| NPI: | 1073005997 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLDSWORTH | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9080 MAIN ROAD | ||||||||
| Address2: | |||||||||
| City: | WEST BLOOMFIELD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145850104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5858808734 | ||||||||
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| Practice Location | |||||||||
| Address1: | 140 CANAL VIEW BLVD | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852795100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2018 | ||||||||
| LastUpdateDate: | 06/26/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WM0705X | 681624 | NY | N | Nursing Service Providers | Registered Nurse | Medical-Surgical | 363LA2200X | 308708 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.