Basic Information
| Provider Information | |||||||||
| NPI: | 1124570031 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLBERT | ||||||||
| FirstName: | HOLLY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | R.N | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 HEALTH CARE DRIVE | ||||||||
| Address2: | |||||||||
| City: | PHILIPPI | ||||||||
| State: | WV | ||||||||
| PostalCode: | 26416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3004457280 | ||||||||
| FaxNumber: | 3044574011 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 HEALTH CARE DRIVE | ||||||||
| Address2: | |||||||||
| City: | PHILIPPI | ||||||||
| State: | WV | ||||||||
| PostalCode: | 264160900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3004457280 | ||||||||
| FaxNumber: | 3044574011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2016 | ||||||||
| LastUpdateDate: | 10/26/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 52739 | WV | Y | Nursing Service Providers | Registered Nurse |
No ID Information.