Provider Demographics
NPI:1831409788
Name:HOLBERT, LINDA ANNE (LPN)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:ANNE
Last Name:HOLBERT
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 1:436 STUMPTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:13733-3260
Mailing Address - Country:US
Mailing Address - Phone:607-206-3086
Mailing Address - Fax:
Practice Address - Street 1:436 STUMPTOWN RD
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:NY
Practice Address - Zip Code:13733-3260
Practice Address - Country:US
Practice Address - Phone:607-206-3086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234525-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse