Basic Information
| Provider Information | |||||||||
| NPI: | 1881974913 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCRIVNER | ||||||||
| FirstName: | HOLLY | ||||||||
| MiddleName: | LYN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1222 GARDEN LN | ||||||||
| Address2: | |||||||||
| City: | GALESBURG | ||||||||
| State: | IL | ||||||||
| PostalCode: | 614012127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3093680877 | ||||||||
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| Practice Location | |||||||||
| Address1: | 872 W DAYTON ST | ||||||||
| Address2: | |||||||||
| City: | GALESBURG | ||||||||
| State: | IL | ||||||||
| PostalCode: | 614011503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3093443400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2011 | ||||||||
| LastUpdateDate: | 08/21/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2500X | 160005266 | IL | Y | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
No ID Information.