Provider Demographics
NPI:1821761750
Name:WHITEHEAD, HOLLEY
Entity Type:Individual
Prefix:
First Name:HOLLEY
Middle Name:
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 AUTOKEE ST
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-1026
Mailing Address - Country:US
Mailing Address - Phone:419-787-7059
Mailing Address - Fax:
Practice Address - Street 1:2040 AUTOKEE ST
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-1026
Practice Address - Country:US
Practice Address - Phone:419-787-7059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide