Provider Demographics
NPI:1437132404
Name:HOLLY, LINDA V (LPN)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:V
Last Name:HOLLY
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 10834
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44110-0834
Mailing Address - Country:US
Mailing Address - Phone:216-990-4834
Mailing Address - Fax:
Practice Address - Street 1:926 E 146TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44110-3704
Practice Address - Country:US
Practice Address - Phone:216-990-4834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN103776164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2263223OtherODJFS PROVIDER NUMBER