MEDICARE: MS. LINDA V HOLLY LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	PN103776	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2263223	OTHER	OH	ODJFS PROVIDER NUMBER

General Provider Information

NPI Number	:	1437132404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LINDA V HOLLY LPN

Provider Business Mailing Address
First Line	:	PO BOX 10834
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44110-0834
Country	:	US
Telephone Number	:	216-990-4834
Fax Number	:

Provider Business Practice Location Address
First Line	:	926 E 146TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44110-3704
Country	:	US
Telephone Number	:	216-990-4834
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	01/08/2024

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