Provider Demographics
NPI:1942822747
Name:CHISHOLM, HOLLY SEARS
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:SEARS
Last Name:CHISHOLM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:SEARS
Other - Last Name:CHISHOLM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:19428 VIA CUESTA
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:CA
Mailing Address - Zip Code:92065-5848
Mailing Address - Country:US
Mailing Address - Phone:858-668-6502
Mailing Address - Fax:
Practice Address - Street 1:9619 CUYAMACA ST # 19428
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-2674
Practice Address - Country:US
Practice Address - Phone:858-668-6502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA644574163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health