Provider Demographics
NPI:1376011064
Name:ECKENRODE, HOLLY (LPN)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:ECKENRODE
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 1:400 LAKEMONT PARK BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-5967
Mailing Address - Country:US
Mailing Address - Phone:814-941-8026
Mailing Address - Fax:814-944-7413
Practice Address - Street 1:400 LAKEMONT PARK BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-5967
Practice Address - Country:US
Practice Address - Phone:814-941-8026
Practice Address - Fax:814-944-7413
Is Sole Proprietor?:No
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN261298L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse