Provider Demographics
NPI:1295816668
Name:HOLLIS, BARBARA ROSE (RN)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:ROSE
Last Name:HOLLIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33105 SANTIAGO RD
Mailing Address - Street 2:#128
Mailing Address - City:ACTON
Mailing Address - State:CA
Mailing Address - Zip Code:93510-1875
Mailing Address - Country:US
Mailing Address - Phone:661-269-2750
Mailing Address - Fax:
Practice Address - Street 1:349A EAST AVE K
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535
Practice Address - Country:US
Practice Address - Phone:661-723-4260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374991163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent