Provider Demographics
NPI:1891122289
Name:ROSS, HOLLY ANN (LPN)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:ANN
Last Name:ROSS
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 1:10310 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BLUE ROCK
Mailing Address - State:OH
Mailing Address - Zip Code:43720-9759
Mailing Address - Country:US
Mailing Address - Phone:740-319-3545
Mailing Address - Fax:
Practice Address - Street 1:10310 CENTER RD
Practice Address - Street 2:
Practice Address - City:BLUE ROCK
Practice Address - State:OH
Practice Address - Zip Code:43720-9759
Practice Address - Country:US
Practice Address - Phone:740-319-3545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-107765164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse