Provider Demographics
NPI:1245067339
Name:HOLBROOK, NEDRA (LPN)
Entity type:Individual
Prefix:
First Name:NEDRA
Middle Name:
Last Name:HOLBROOK
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 1:726 FOX CHASE CIR
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-2705
Mailing Address - Country:US
Mailing Address - Phone:302-580-6208
Mailing Address - Fax:
Practice Address - Street 1:726 FOX CHASE CIR
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-2705
Practice Address - Country:US
Practice Address - Phone:302-580-6208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL2-0013585164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse