Healthcare Provider Details

I. General information

NPI: 1689984015
Provider Name (Legal Business Name): HOLLY ELAINE WHITT LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2010
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8652 STATE ROUTE 41
ABERDEEN OH
45101-9730
US

IV. Provider business mailing address

8652 STATE ROUTE 41
ABERDEEN OH
45101-9730
US

V. Phone/Fax

Practice location:
  • Phone: 937-795-2171
  • Fax:
Mailing address:
  • Phone: 937-795-2171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN 132693
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: