Provider Demographics
NPI:1871815969
Name:HOLLIS, IRIS (RN)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:HOLLIS
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 SPRING BROOK CT
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-8058
Mailing Address - Country:US
Mailing Address - Phone:614-560-7316
Mailing Address - Fax:
Practice Address - Street 1:108 SPRING BROOK CT
Practice Address - Street 2:
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062-8058
Practice Address - Country:US
Practice Address - Phone:614-560-7316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.346599163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse