Provider Demographics
NPI:1801267190
Name:SPILLER, HOLLY (LPN,)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:
Last Name:SPILLER
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 1:253 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-3739
Mailing Address - Country:US
Mailing Address - Phone:716-472-6753
Mailing Address - Fax:
Practice Address - Street 1:253 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3739
Practice Address - Country:US
Practice Address - Phone:716-472-6753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-12
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY322649164W00000X
NY761429163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse