Provider Demographics
NPI:1063232924
Name:HOLTER, CARRIE DIANE (LPN, ASSOCIATES,)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:DIANE
Last Name:HOLTER
Suffix:
Gender:F
Credentials:LPN, ASSOCIATES,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50060 RAINBOW RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LONG BOTTOM
Mailing Address - State:OH
Mailing Address - Zip Code:45743-9001
Mailing Address - Country:US
Mailing Address - Phone:740-416-9761
Mailing Address - Fax:
Practice Address - Street 1:117 W MAIN ST STE 107
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3799
Practice Address - Country:US
Practice Address - Phone:740-500-0484
Practice Address - Fax:740-421-3193
Is Sole Proprietor?:No
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.096375.MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse