Provider Demographics
NPI:1225495872
Name:HOLLEY, QUANEISHA
Entity Type:Individual
Prefix:
First Name:QUANEISHA
Middle Name:
Last Name:HOLLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:QUANEISHA
Other - Middle Name:
Other - Last Name:HOLLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:415 AFFINITY LN
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14616-1703
Mailing Address - Country:US
Mailing Address - Phone:585-489-0167
Mailing Address - Fax:
Practice Address - Street 1:415 AFFINITY LN
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14616-1703
Practice Address - Country:US
Practice Address - Phone:585-489-0167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY324526-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse