Provider Demographics
NPI:1831479757
Name:HOLLY, BARBARA J (RN)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:J
Last Name:HOLLY
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 1:108 SW MEMORIAL PL
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97331-8667
Mailing Address - Country:US
Mailing Address - Phone:541-737-9355
Mailing Address - Fax:541-737-4530
Practice Address - Street 1:108 SW MEMORIAL PL
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97331-8667
Practice Address - Country:US
Practice Address - Phone:541-737-9355
Practice Address - Fax:541-737-4530
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR078041214RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse