Provider Demographics
NPI:1821245978
Name:JENKINSON, HOLLY LYN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:LYN
Last Name:JENKINSON
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 1:139 WALNUT LN
Mailing Address - Street 2:
Mailing Address - City:STAATSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12580-6347
Mailing Address - Country:US
Mailing Address - Phone:845-266-3695
Mailing Address - Fax:845-473-5900
Practice Address - Street 1:139 WALNUT LN
Practice Address - Street 2:
Practice Address - City:STAATSBURG
Practice Address - State:NY
Practice Address - Zip Code:12580-6347
Practice Address - Country:US
Practice Address - Phone:845-266-3695
Practice Address - Fax:845-473-5900
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177992-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse