Provider Demographics
NPI:1508164229
Name:STOLTZ, HOLLY ANN (LPN)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:ANN
Last Name:STOLTZ
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 1:10595 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44064-9794
Mailing Address - Country:US
Mailing Address - Phone:440-968-3629
Mailing Address - Fax:
Practice Address - Street 1:10595 CLAY ST
Practice Address - Street 2:
Practice Address - City:MONTVILLE
Practice Address - State:OH
Practice Address - Zip Code:44064-9794
Practice Address - Country:US
Practice Address - Phone:440-968-3629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.085652-MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse