Provider Demographics
NPI:1780246082
Name:HOLBROOK, KARA JANE (LPN)
Entity type:Individual
Prefix:MS
First Name:KARA
Middle Name:JANE
Last Name:HOLBROOK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3060 N LAZY EIGHT CT STE 2
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-4331
Mailing Address - Country:US
Mailing Address - Phone:907-414-8774
Mailing Address - Fax:
Practice Address - Street 1:2521 E MOUNTAIN VILLAGE DR STE F
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7373
Practice Address - Country:US
Practice Address - Phone:907-290-3760
Practice Address - Fax:907-631-0647
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK134562164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse