Provider Demographics
NPI:1336357664
Name:HOLLINS, CHANDRA LAUREEN (STNA)
Entity Type:Individual
Prefix:MS
First Name:CHANDRA
Middle Name:LAUREEN
Last Name:HOLLINS
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6311 FENCE ROW LN
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-9787
Mailing Address - Country:US
Mailing Address - Phone:614-920-2844
Mailing Address - Fax:
Practice Address - Street 1:6311 FENCE ROW LN
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-9787
Practice Address - Country:US
Practice Address - Phone:614-920-2844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400394510804376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2713022Medicaid