MEDICARE: HOLLY HESKETT RN

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	364SC0200X	Critical Care Medicine Clinical Nurse Specialist	RN.393870	OH

General Provider Information

NPI Number	:	1699441592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY HESKETT RN

Provider Business Mailing Address
First Line	:	4273 LE BEAU DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45244-2317
Country	:	US
Telephone Number	:	513-504-2450
Fax Number	:

Provider Business Practice Location Address
First Line	:	4273 LE BEAU DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45244-2317
Country	:	US
Telephone Number	:	513-504-2450
Fax Number	:

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

Provider Enumeration Date	:	08/19/2021
Last Update Date	:	08/19/2021

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