Provider Demographics
NPI:1528185295
Name:HOLLIS, KAREN J (RN)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:J
Last Name:HOLLIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 1454
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:MO
Mailing Address - Zip Code:65606-9730
Mailing Address - Country:US
Mailing Address - Phone:417-778-7267
Mailing Address - Fax:417-778-7267
Practice Address - Street 1:RR 1 BOX 1454
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:MO
Practice Address - Zip Code:65606-9730
Practice Address - Country:US
Practice Address - Phone:417-778-7267
Practice Address - Fax:417-778-7267
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities