Individual
HOLLY RAE STATHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1302 CHILDRESS ST, WELLINGTON, TX 79095-3626
(806) 205-1494
Mailing address
1302 CHILDRESS ST, WELLINGTON, TX 79095-3626
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
346124
TX
Other
Enumeration date
03/11/2019
Last updated
03/11/2019
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