Provider Demographics
NPI:1396505830
Name:HOLLOMAN, JOYCE LAVETTE (LPN)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:LAVETTE
Last Name:HOLLOMAN
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 1:542 CANON CIR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-2648
Mailing Address - Country:US
Mailing Address - Phone:413-219-2045
Mailing Address - Fax:
Practice Address - Street 1:542 CANON CIR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01118-2648
Practice Address - Country:US
Practice Address - Phone:413-219-2045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN92609164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse