Provider Demographics
NPI:1467584946
Name:HOLLINGSWORTH, ROBERTA JOANN (RN)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:JOANN
Last Name:HOLLINGSWORTH
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 1:4840 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-5859
Mailing Address - Country:US
Mailing Address - Phone:440-942-4590
Mailing Address - Fax:
Practice Address - Street 1:4840 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-5859
Practice Address - Country:US
Practice Address - Phone:440-942-4590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN192056163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2498784Medicaid