Provider Demographics
NPI:1588237234
Name:GHOLSON, ORA
Entity Type:Individual
Prefix:
First Name:ORA
Middle Name:
Last Name:GHOLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6014 W AUGUSTA AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-1234
Mailing Address - Country:US
Mailing Address - Phone:623-393-9626
Mailing Address - Fax:
Practice Address - Street 1:6014 W AUGUSTA AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-1234
Practice Address - Country:US
Practice Address - Phone:623-393-9626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
84-2697163OtherHOME HEALTH CARE