MEDICARE: MS. CHANDRA LAUREEN HOLLINS STNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	400394510804	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336357664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHANDRA LAUREEN HOLLINS STNA

Provider Business Mailing Address
First Line	:	6311 FENCE ROW LN
Second Line	:
City	:	CANAL WINCHESTER
State	:	OH
Zip	:	43110-9787
Country	:	US
Telephone Number	:	614-920-2844
Fax Number	:

Provider Business Practice Location Address
First Line	:	6311 FENCE ROW LN
Second Line	:
City	:	CANAL WINCHESTER
State	:	OH
Zip	:	43110-9787
Country	:	US
Telephone Number	:	614-920-2844
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	07/09/2007

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