Provider Demographics
NPI:1003232562
Name:SMITS, HOLLY SUE (LPN)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:SUE
Last Name:SMITS
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 1:1559 MULLINS AVE NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49534-2432
Mailing Address - Country:US
Mailing Address - Phone:616-742-0531
Mailing Address - Fax:616-742-0370
Practice Address - Street 1:72 SHELDON BLVD SE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4234
Practice Address - Country:US
Practice Address - Phone:616-742-3051
Practice Address - Fax:616-742-3070
Is Sole Proprietor?:No
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703111783164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse