Provider Demographics
NPI:1609330521
Name:DRAHOTA, HOLLAN RHAE (BSN, RN)
Entity Type:Individual
Prefix:MRS
First Name:HOLLAN
Middle Name:RHAE
Last Name:DRAHOTA
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4403 S 153RD CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-5125
Mailing Address - Country:US
Mailing Address - Phone:402-640-3058
Mailing Address - Fax:
Practice Address - Street 1:10520 S 123RD AVE
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-4393
Practice Address - Country:US
Practice Address - Phone:402-514-3650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE78435163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool