Provider Demographics
NPI:1396268637
Name:HOLLINGSHEAD, LAURA DIANE (RN,CDE)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:DIANE
Last Name:HOLLINGSHEAD
Suffix:
Gender:F
Credentials:RN,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1891
Mailing Address - Street 2:
Mailing Address - City:OROFINO
Mailing Address - State:ID
Mailing Address - Zip Code:83544-1891
Mailing Address - Country:US
Mailing Address - Phone:208-940-0282
Mailing Address - Fax:
Practice Address - Street 1:420 ADAMS ROAD
Practice Address - Street 2:
Practice Address - City:OROFINO
Practice Address - State:ID
Practice Address - Zip Code:83544-8354
Practice Address - Country:US
Practice Address - Phone:208-940-0282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-30719163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator