Provider Demographics
NPI:1770021933
Name:DUNHAM, HOLLI EDEN (FNP-C)
Entity Type:Individual
Prefix:
First Name:HOLLI
Middle Name:EDEN
Last Name:DUNHAM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 CALDWELL RD
Mailing Address - Street 2:
Mailing Address - City:LUCASVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45648-8346
Mailing Address - Country:US
Mailing Address - Phone:740-352-7164
Mailing Address - Fax:
Practice Address - Street 1:12340 STATE ROUTE 104
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690-8968
Practice Address - Country:US
Practice Address - Phone:740-941-5180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-08
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.341688363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily