Provider Demographics
NPI:1285095570
Name:SHUMAKER, HOLLY (LPN)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:SHUMAKER
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 1:641 NORMANDY DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6643
Mailing Address - Country:US
Mailing Address - Phone:740-361-5249
Mailing Address - Fax:
Practice Address - Street 1:641 NORMANDY DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6643
Practice Address - Country:US
Practice Address - Phone:740-361-5249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH150409164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse