Provider Demographics
NPI:1609993013
Name:INMAN, HOLLY L (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:L
Last Name:INMAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 CANTON RD NW STE A
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:44615-1009
Mailing Address - Country:US
Mailing Address - Phone:330-627-8163
Mailing Address - Fax:330-627-0197
Practice Address - Street 1:125 CANTON RD NW STE A
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:44615-1009
Practice Address - Country:US
Practice Address - Phone:330-627-8163
Practice Address - Fax:330-627-0197
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH160406363LF0000X
OHAPRN.CNP.08574363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2615709Medicaid