Provider Demographics
NPI:1689984015
Name:WHITT, HOLLY ELAINE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:ELAINE
Last Name:WHITT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8652 STATE ROUTE 41
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:OH
Mailing Address - Zip Code:45101-9730
Mailing Address - Country:US
Mailing Address - Phone:937-795-2171
Mailing Address - Fax:
Practice Address - Street 1:8652 STATE ROUTE 41
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:OH
Practice Address - Zip Code:45101-9730
Practice Address - Country:US
Practice Address - Phone:937-795-2171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 132693164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse