Provider Demographics
NPI:1285802280
Name:SEE, HOLLY JANICE (RN)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:JANICE
Last Name:SEE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 62 BOX 60B
Mailing Address - Street 2:
Mailing Address - City:UPPER TRACT
Mailing Address - State:WV
Mailing Address - Zip Code:26866-9713
Mailing Address - Country:US
Mailing Address - Phone:304-358-3182
Mailing Address - Fax:
Practice Address - Street 1:108 WALNUT ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WV
Practice Address - Zip Code:26807
Practice Address - Country:US
Practice Address - Phone:304-358-2207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV55897163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9702019000Medicaid