Provider Demographics
NPI:1396852208
Name:HAMBERLIN, HOLLY (LPN)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:
Last Name:HAMBERLIN
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 1:15337 HIGHWAY 8
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:LA
Mailing Address - Zip Code:71417-5055
Mailing Address - Country:US
Mailing Address - Phone:318-794-1869
Mailing Address - Fax:
Practice Address - Street 1:CLSH/RRTC
Practice Address - Street 2:UNIT # 6 MEADOW LANE
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360
Practice Address - Country:US
Practice Address - Phone:318-484-6354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA260111164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse