Provider Demographics
NPI:1467797829
Name:HOLLAND ENNIST, EMMA LOUISE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:EMMA
Middle Name:LOUISE
Last Name:HOLLAND ENNIST
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:EMMA
Other - Middle Name:LOUISE
Other - Last Name:HOLLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:23 SELLET RD
Mailing Address - Street 2:
Mailing Address - City:PINE BUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12566-5340
Mailing Address - Country:US
Mailing Address - Phone:845-800-2884
Mailing Address - Fax:
Practice Address - Street 1:23 SELLET RD
Practice Address - Street 2:
Practice Address - City:PINE BUSH
Practice Address - State:NY
Practice Address - Zip Code:12566-5340
Practice Address - Country:US
Practice Address - Phone:845-800-2884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306454-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse