Individual
LEROY KENNETH HOLLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
324 N ASH ST, CORTEZ, CO 81321-2812
(970) 564-0152
Mailing address
324 N ASH ST, CORTEZ, CO 81321-2812
(970) 564-0152
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN0330637
CO
Other
Enumeration date
08/20/2013
Last updated
08/20/2013
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