Healthcare Provider Details

I. General information

NPI: 1891407318
Provider Name (Legal Business Name): HOLLY ANN HIGGINBOTTHAM RN,BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2022
Last Update Date: 12/15/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15655 OH 170
CALCUTTA OH
43920
US

IV. Provider business mailing address

6399 S TIMBERIDGE DR
AUSTINTOWN OH
44515-5616
US

V. Phone/Fax

Practice location:
  • Phone: 330-386-4303
  • Fax:
Mailing address:
  • Phone: 330-398-6919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN312513
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: