Provider Demographics
NPI:1396367579
Name:HOLLIMON, MICHELLE ETOLIE
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ETOLIE
Last Name:HOLLIMON
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 1:5620 INDIAN TRL
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-7365
Mailing Address - Country:US
Mailing Address - Phone:757-338-3232
Mailing Address - Fax:
Practice Address - Street 1:5620 INDIAN TRL
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-7365
Practice Address - Country:US
Practice Address - Phone:757-338-3232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health