Provider Demographics
NPI:1851562482
Name:TARKALSON, HOLLY A (RN)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:A
Last Name:TARKALSON
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:P.O. BOX 281
Mailing Address - Street 2:
Mailing Address - City:VERNONIA
Mailing Address - State:OR
Mailing Address - Zip Code:97064
Mailing Address - Country:US
Mailing Address - Phone:503-429-4527
Mailing Address - Fax:
Practice Address - Street 1:61161 STONEY POINT RD
Practice Address - Street 2:
Practice Address - City:VERNONIA
Practice Address - State:OR
Practice Address - Zip Code:97064-9429
Practice Address - Country:US
Practice Address - Phone:503-429-4527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse