Healthcare Provider Details

I. General information

NPI: 1285355867
Provider Name (Legal Business Name): CHANTONIQUE M HOLLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 09/12/2022
Certification Date: 09/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 NEBRASKA AVE
TOLEDO OH
43607-3527
US

IV. Provider business mailing address

2350 NEBRASKA AVE
TOLEDO OH
43607-3527
US

V. Phone/Fax

Practice location:
  • Phone: 734-717-3037
  • Fax:
Mailing address:
  • Phone: 734-717-3037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number182948.MEDS-IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: