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General NPI Number Information
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NPI Number | 1669091179
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Entity Type | Individual
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Provider Name | MRS. VIVIAN ELAINE HOLLISTER
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Gender | Female
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Dates
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Enumeration Date | 04/14/2020
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Last Update Date | 04/14/2020
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Provider Practice Location Address
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Address Line | 1579 LCR 310
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City | MART, TEXAS
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State | TX
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Zip | 76664-5206
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Country | US
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Telephone | 254-344-2217
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Fax | 254-344-2217
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Provider Business Mailing Address
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Address Line | 1579 LCR 310
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City | MART, TEXAS
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State | TX
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Zip | 76664-5206
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Country | US
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Telephone | 254-344-2217
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Fax | 254-344-2217
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 000422
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License Number State | TX
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