Provider Demographics
NPI:1033449756
Name:HOLCOMB, VONDA M (LPN)
Entity Type:Individual
Prefix:MRS
First Name:VONDA
Middle Name:M
Last Name:HOLCOMB
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 1:1713 FRESHOUR RD
Mailing Address - Street 2:
Mailing Address - City:SHORTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14548-9215
Mailing Address - Country:US
Mailing Address - Phone:585-289-6935
Mailing Address - Fax:
Practice Address - Street 1:1713 FRESHOUR RD
Practice Address - Street 2:
Practice Address - City:SHORTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14548-9215
Practice Address - Country:US
Practice Address - Phone:585-289-6935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-31
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243593164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse