Provider Demographics
NPI:1841560976
Name:HOLSTON, HEATHER LEE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LEE
Last Name:HOLSTON
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:PO BOX 363
Mailing Address - Street 2:162 E. 6TH
Mailing Address - City:LOWELL
Mailing Address - State:OR
Mailing Address - Zip Code:97452-0363
Mailing Address - Country:US
Mailing Address - Phone:541-937-8586
Mailing Address - Fax:541-937-8586
Practice Address - Street 1:425 ALEXANDER LOOP
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6524
Practice Address - Country:US
Practice Address - Phone:541-345-6199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-05
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201130222LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse