Provider Demographics
NPI:1932641370
Name:LEMMONS, HOLLY (LPN, ACSM)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:LEMMONS
Suffix:
Gender:F
Credentials:LPN, ACSM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2406 S STATE ROAD 45
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47462-6351
Mailing Address - Country:US
Mailing Address - Phone:870-324-0277
Mailing Address - Fax:
Practice Address - Street 1:2406 S STATE ROAD 45
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:IN
Practice Address - Zip Code:47462-6351
Practice Address - Country:US
Practice Address - Phone:870-324-0277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27071710A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse