Provider Demographics
NPI:1992403539
Name:CONLEY, HOLLY NICOLE (LPN)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:NICOLE
Last Name:CONLEY
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 1:12469 STATE HIGHWAY 294
Mailing Address - Street 2:
Mailing Address - City:UPPER SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:43351-9254
Mailing Address - Country:US
Mailing Address - Phone:419-310-5030
Mailing Address - Fax:
Practice Address - Street 1:12469 STATE HIGHWAY 294
Practice Address - Street 2:
Practice Address - City:UPPER SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:43351-9254
Practice Address - Country:US
Practice Address - Phone:419-310-5030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-22
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.136697.MEDS.IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse