Provider Demographics
NPI:1700924339
Name:NIED, HOLLY ANNE (LPN)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:ANNE
Last Name:NIED
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 1:1710 HENDRICKS DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-5121
Mailing Address - Country:US
Mailing Address - Phone:734-240-0608
Mailing Address - Fax:734-240-0608
Practice Address - Street 1:1710 HENDRICKS DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-5121
Practice Address - Country:US
Practice Address - Phone:734-240-0608
Practice Address - Fax:734-240-0608
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-093612164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2693894Medicaid