Provider Demographics
NPI:1306280524
Name:MCCOY, HOLLY VANESSA (STNA)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:VANESSA
Last Name:MCCOY
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 S UNION ST
Mailing Address - Street 2:
Mailing Address - City:GALION
Mailing Address - State:OH
Mailing Address - Zip Code:44833-2546
Mailing Address - Country:US
Mailing Address - Phone:419-564-4523
Mailing Address - Fax:
Practice Address - Street 1:447 S UNION ST
Practice Address - Street 2:
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833-2547
Practice Address - Country:US
Practice Address - Phone:567-274-9889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2013-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401421970712376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide