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General NPI Number Information
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NPI Number | 1831806553
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Entity Type | Individual
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Provider Name | LATRISHA HOLLMON
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Gender | Female
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Dates
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Enumeration Date | 11/02/2022
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Last Update Date | 11/02/2022
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Provider Practice Location Address
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Address Line | 7050 CENTENNIAL DR
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City | TINLEY PARK
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State | IL
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Zip | 60477-1649
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Country | US
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Telephone | 708-535-6812
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Fax |
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Provider Business Mailing Address
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Address Line | 3813 169TH ST
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City | COUNTRY CLUB HILLS
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State | IL
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Zip | 60478-2137
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Country | US
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Telephone | 773-406-7564
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Fax |
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 043.116475
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License Number State | IL
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