Provider Demographics
NPI:1477257327
Name:OLMSTEAD, HOLLY M (LPN)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:M
Last Name:OLMSTEAD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:DOOLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1601 OLD SOUTH RIVER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-4120
Mailing Address - Country:US
Mailing Address - Phone:636-224-1210
Mailing Address - Fax:636-246-1008
Practice Address - Street 1:1628 OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MO
Practice Address - Zip Code:64683-2565
Practice Address - Country:US
Practice Address - Phone:660-359-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014032507164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse