Provider Demographics
NPI:1235714015
Name:HOLLIS, KIRSTEN RENAE
Entity Type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:RENAE
Last Name:HOLLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8889 STATE ROUTE 64
Mailing Address - Street 2:
Mailing Address - City:SWANTON
Mailing Address - State:OH
Mailing Address - Zip Code:43558-9787
Mailing Address - Country:US
Mailing Address - Phone:910-551-2751
Mailing Address - Fax:
Practice Address - Street 1:8889 STATE ROUTE 64
Practice Address - Street 2:
Practice Address - City:SWANTON
Practice Address - State:OH
Practice Address - Zip Code:43558-9787
Practice Address - Country:US
Practice Address - Phone:910-551-2751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-13
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker