Healthcare Provider Details

I. General information

NPI: 1235714015
Provider Name (Legal Business Name): MRS. KIRSTEN RENAE HOLLIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2021
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2306 TORREY HILL DR APT 7
TOLEDO OH
43606-4380
US

IV. Provider business mailing address

2306 TORREY HILL DR APT 7
TOLEDO OH
43606-4380
US

V. Phone/Fax

Practice location:
  • Phone: 567-901-2088
  • Fax:
Mailing address:
  • Phone: 567-901-2088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: