Provider Demographics
NPI:1003067299
Name:HOLLEY, JULIE J (LPN)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:J
Last Name:HOLLEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 IRONDALE CIR NE
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-2157
Mailing Address - Country:US
Mailing Address - Phone:330-966-7044
Mailing Address - Fax:
Practice Address - Street 1:1345 IRONDALE CIR NE
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-2157
Practice Address - Country:US
Practice Address - Phone:330-966-7044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN060452164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse