Provider Demographics
NPI:1659856433
Name:COMPO, HOLLY JO (RN, PHN)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:JO
Last Name:COMPO
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 COMPO LN
Mailing Address - Street 2:
Mailing Address - City:ESKO
Mailing Address - State:MN
Mailing Address - Zip Code:55733-9424
Mailing Address - Country:US
Mailing Address - Phone:218-390-7852
Mailing Address - Fax:
Practice Address - Street 1:707 HIGHWAY 33 S STE 12
Practice Address - Street 2:
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-2665
Practice Address - Country:US
Practice Address - Phone:218-879-6768
Practice Address - Fax:218-879-5313
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1793222163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse