Basic Information
| Provider Information | |||||||||
| NPI: | 1043684756 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHURCHILL | ||||||||
| FirstName: | HOLLY | ||||||||
| MiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 725 NE 24TH ST | ||||||||
| Address2: | |||||||||
| City: | MCMINNVILLE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971282105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9719012331 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 625 NE GALLOWAY ST | ||||||||
| Address2: | |||||||||
| City: | MCMINNVILLE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971283933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034347523 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2015 | ||||||||
| LastUpdateDate: | 05/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 201602402RN | OR | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 163WH0200X | R 161857-2 | MN | N | Nursing Service Providers | Registered Nurse | Home Health |
No ID Information.