Provider Demographics
NPI:1588296545
Name:HOLLIDAY, GARNET KB (RN, BSN, LCCE)
Entity type:Individual
Prefix:
First Name:GARNET
Middle Name:KB
Last Name:HOLLIDAY
Suffix:
Gender:F
Credentials:RN, BSN, LCCE
Other - Prefix:
Other - First Name:GARNET
Other - Middle Name:K
Other - Last Name:BYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:315 FARMER DR
Mailing Address - Street 2:
Mailing Address - City:MEDWAY
Mailing Address - State:OH
Mailing Address - Zip Code:45341-9510
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:315 FARMER DR
Practice Address - Street 2:
Practice Address - City:MEDWAY
Practice Address - State:OH
Practice Address - Zip Code:45341-9510
Practice Address - Country:US
Practice Address - Phone:937-902-1289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-07
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.177358163WP0808X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health