Provider Demographics
NPI:1952732174
Name:MCBRIDE, HOLLY (LPN)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:MCBRIDE
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 1:8832 E PUEBLO AVE LOT 79
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85208-2942
Mailing Address - Country:US
Mailing Address - Phone:480-359-9043
Mailing Address - Fax:
Practice Address - Street 1:10211 E MADERO AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-1493
Practice Address - Country:US
Practice Address - Phone:480-635-2025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPO39250164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse