Provider Demographics
NPI:1407173297
Name:HOLFORD, MANDY IRENE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MANDY
Middle Name:IRENE
Last Name:HOLFORD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:MANDY
Other - Middle Name:IRENE
Other - Last Name:HORN WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1745 NE KLAMATH AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-2119
Mailing Address - Country:US
Mailing Address - Phone:541-672-5297
Mailing Address - Fax:541-672-5297
Practice Address - Street 1:1745 NE KLAMATH AVE
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-2119
Practice Address - Country:US
Practice Address - Phone:541-672-5297
Practice Address - Fax:541-672-5297
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLPN000006013164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORLPN000006013OtherSTATE BOARD OF NURSING