Provider Demographics
NPI:1215682166
Name:HOLBROOK, OKSANA (RN)
Entity type:Individual
Prefix:
First Name:OKSANA
Middle Name:
Last Name:HOLBROOK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:OKSANA
Other - Middle Name:
Other - Last Name:LYSOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:724 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:GRIMES
Mailing Address - State:IA
Mailing Address - Zip Code:50111-1076
Mailing Address - Country:US
Mailing Address - Phone:515-490-7920
Mailing Address - Fax:
Practice Address - Street 1:3600 30TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-5753
Practice Address - Country:US
Practice Address - Phone:515-699-5999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA126158163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse