Provider Demographics
NPI:1992107965
Name:COLE, HOLLY I
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:COLE
Suffix:I
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:HOLLY
Other - Middle Name:NICHELLE
Other - Last Name:COLE
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:N/A
Mailing Address - Street 1:2667 LONGVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45663-6332
Mailing Address - Country:US
Mailing Address - Phone:740-352-2804
Mailing Address - Fax:
Practice Address - Street 1:2667 LONGVIEW AVE
Practice Address - Street 2:
Practice Address - City:WEST PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45663-6332
Practice Address - Country:US
Practice Address - Phone:740-352-2804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide