Provider Demographics
NPI:1609839463
Name:LASHMET, HOLLY V (CRNA)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:V
Last Name:LASHMET
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 10TH ST E
Mailing Address - Street 2:
Mailing Address - City:MOBRIDGE
Mailing Address - State:SD
Mailing Address - Zip Code:57601-1813
Mailing Address - Country:US
Mailing Address - Phone:605-845-3502
Mailing Address - Fax:605-845-3502
Practice Address - Street 1:1401 10TH AVE W
Practice Address - Street 2:
Practice Address - City:MOBRIDGE
Practice Address - State:SD
Practice Address - Zip Code:57601
Practice Address - Country:US
Practice Address - Phone:605-845-8271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE66586163WC0200X
NE100997282NC0060X, 363L00000X, 367500000X
SDCR000953367500000X
CO5341367500000X, 261QE0800X, 282N00000X, 282NC0060X
KS55417261QE0800X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD470421272Medicaid
NE470421272Medicaid
KS200304330AMedicaid