Provider Demographics
NPI:1609113158
Name:HOLLENBECK, ALESSANDRA LEE (LPN)
Entity Type:Individual
Prefix:
First Name:ALESSANDRA
Middle Name:LEE
Last Name:HOLLENBECK
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 1:346 INDIAN MOUND PKWY
Mailing Address - Street 2:
Mailing Address - City:WHITEWATER
Mailing Address - State:WI
Mailing Address - Zip Code:53190-1558
Mailing Address - Country:US
Mailing Address - Phone:920-728-2520
Mailing Address - Fax:
Practice Address - Street 1:346 INDIAN MOUND PKWY
Practice Address - Street 2:
Practice Address - City:WHITEWATER
Practice Address - State:WI
Practice Address - Zip Code:53190-1558
Practice Address - Country:US
Practice Address - Phone:920-728-2520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI316223-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse