Provider Demographics
NPI:1417912312
Name:HOLBROOK, CAROLINE LUCY (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:LUCY
Last Name:HOLBROOK
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:PO BOX 1120
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44005-1120
Mailing Address - Country:US
Mailing Address - Phone:440-344-4579
Mailing Address - Fax:440-224-0916
Practice Address - Street 1:4321 NORTH MONROE CTR RD
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44048
Practice Address - Country:US
Practice Address - Phone:440-224-0130
Practice Address - Fax:440-224-0916
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN096801164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH213338Medicare PIN