Provider Demographics
NPI:1750661237
Name:HOLLENBECK, NAOMI (LPN)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:HOLLENBECK
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 1:16 PENDLETON ST
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-2211
Mailing Address - Country:US
Mailing Address - Phone:607-227-4588
Mailing Address - Fax:
Practice Address - Street 1:16 PENDLETON ST
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-2211
Practice Address - Country:US
Practice Address - Phone:607-227-4588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-28
Last Update Date:2011-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY279496164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse