Provider Demographics
NPI:1740814862
Name:SPRICK, HOLLY JEAN (RN)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:JEAN
Last Name:SPRICK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4639 52ND ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-9303
Mailing Address - Country:US
Mailing Address - Phone:616-826-3500
Mailing Address - Fax:
Practice Address - Street 1:4639 52ND ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-9303
Practice Address - Country:US
Practice Address - Phone:616-826-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704199896163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse