Provider Demographics
NPI:1710569926
Name:HOLBROOK, JOANNA LYNN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:LYNN
Last Name:HOLBROOK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:LYNN
Other - Last Name:TANNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:475 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-1501
Mailing Address - Country:US
Mailing Address - Phone:419-419-5705
Mailing Address - Fax:419-775-1254
Practice Address - Street 1:475 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-1501
Practice Address - Country:US
Practice Address - Phone:419-419-5705
Practice Address - Fax:419-775-1254
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH075320164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse