Provider Demographics
NPI:1427606029
Name:WEBBER, HOLLY MALONE (RN)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:MALONE
Last Name:WEBBER
Suffix:
Gender:F
Credentials:RN
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 2627
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72303-2627
Mailing Address - Country:US
Mailing Address - Phone:870-733-9950
Mailing Address - Fax:870-733-9966
Practice Address - Street 1:1600 AVONDALE CIR
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-1794
Practice Address - Country:US
Practice Address - Phone:870-733-9950
Practice Address - Fax:870-733-9966
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR100173163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool