Provider Demographics
NPI:1740617034
Name:BROOKS, HOLLY BETH (LPN)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:BETH
Last Name:BROOKS
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 1:96 PRIVATE DRIVE 426
Mailing Address - Street 2:COUNTY ROAD 7A
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-8340
Mailing Address - Country:US
Mailing Address - Phone:740-532-3796
Mailing Address - Fax:
Practice Address - Street 1:96 PRIVATE DRIVE 426
Practice Address - Street 2:COUNTY ROAD 7A
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-8340
Practice Address - Country:US
Practice Address - Phone:740-532-3796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 129906164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse