Provider Demographics
NPI:1043565849
Name:IMLER, HOLLIE JOY (LPN)
Entity Type:Individual
Prefix:
First Name:HOLLIE
Middle Name:JOY
Last Name:IMLER
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 1:5819 ASTER ST
Mailing Address - Street 2:4
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478-4918
Mailing Address - Country:US
Mailing Address - Phone:541-505-2999
Mailing Address - Fax:
Practice Address - Street 1:5819 ASTER ST
Practice Address - Street 2:4
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97478-4918
Practice Address - Country:US
Practice Address - Phone:541-726-4129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201230190LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse