Provider Demographics
NPI:1861658601
Name:HOLT, VICKI LYNNE (LPN)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:LYNNE
Last Name:HOLT
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 1:5401 LOWER TWIN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:45681-9706
Mailing Address - Country:US
Mailing Address - Phone:937-981-4235
Mailing Address - Fax:937-981-4235
Practice Address - Street 1:410 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:OH
Practice Address - Zip Code:45123-1355
Practice Address - Country:US
Practice Address - Phone:937-402-0390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN06382164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPN063824OtherOHIO BOARD OF NURSING