Provider Demographics
NPI:1043572241
Name:VANHOLTZ, AMY LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:VANHOLTZ
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 1:930 OLD SENECA TPKE
Mailing Address - Street 2:
Mailing Address - City:SKANEATELES
Mailing Address - State:NY
Mailing Address - Zip Code:13152-9318
Mailing Address - Country:US
Mailing Address - Phone:315-685-5839
Mailing Address - Fax:315-664-9279
Practice Address - Street 1:930 OLD SENECA TPKE
Practice Address - Street 2:
Practice Address - City:SKANEATELES
Practice Address - State:NY
Practice Address - Zip Code:13152-9318
Practice Address - Country:US
Practice Address - Phone:315-685-5839
Practice Address - Fax:315-664-9279
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY298546164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse