Provider Demographics
NPI:1497991186
Name:HOLM, MOLLY SUSANNAH (LPN)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:SUSANNAH
Last Name:HOLM
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 1:38 ANDREW LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT TREMPER
Mailing Address - State:NY
Mailing Address - Zip Code:12457-5315
Mailing Address - Country:US
Mailing Address - Phone:845-657-8999
Mailing Address - Fax:
Practice Address - Street 1:38 ANDREW LN
Practice Address - Street 2:
Practice Address - City:MOUNT TREMPER
Practice Address - State:NY
Practice Address - Zip Code:12457-5315
Practice Address - Country:US
Practice Address - Phone:845-657-8999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY287264164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse