Provider Demographics
NPI:1679180038
Name:HOLBERT, SHAUNA S
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:S
Last Name:HOLBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3575 FARMSTEAD DR
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-8683
Mailing Address - Country:US
Mailing Address - Phone:614-774-7025
Mailing Address - Fax:
Practice Address - Street 1:3575 FARMSTEAD DR
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-8683
Practice Address - Country:US
Practice Address - Phone:614-774-7025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2671783372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion