Provider Demographics
NPI:1154806214
Name:RICHARD, HOLLY (LPN)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:RICHARD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 JESSUP SWITCH RD
Mailing Address - Street 2:
Mailing Address - City:FLORIDA
Mailing Address - State:NY
Mailing Address - Zip Code:10921-2901
Mailing Address - Country:US
Mailing Address - Phone:845-545-7392
Mailing Address - Fax:
Practice Address - Street 1:86 JESSUP SWITCH RD
Practice Address - Street 2:
Practice Address - City:FLORIDA
Practice Address - State:NY
Practice Address - Zip Code:10921-2901
Practice Address - Country:US
Practice Address - Phone:845-545-7392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332716-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse