Individual
MRS. TAINA S. HOLLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1234 ELGIN WAY, RIVERDALE, GA 30296
(770) 629-1565
Mailing address
1234 ELGIN WAY, RIVERDALE, GA 30296
(770) 629-1565
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN061999
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
031012479
GA OFFICE OF REG. SERVICE
GA
Enumeration date
04/15/2009
Last updated
04/15/2009
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