Provider Demographics
NPI:1942704325
Name:LUZADER, HOLLY MARIE (MSN, APRN, CPNP-PC)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:MARIE
Last Name:LUZADER
Suffix:
Gender:F
Credentials:MSN, APRN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 DALE DR
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-9171
Mailing Address - Country:US
Mailing Address - Phone:330-464-8257
Mailing Address - Fax:
Practice Address - Street 1:3925 DARROW RD STE 105
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-2600
Practice Address - Country:US
Practice Address - Phone:330-686-8424
Practice Address - Fax:330-686-7810
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.021624363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics