1396183273 NPI number — MRS. CHERYL RENEE HOLLINGSWORTH R.N., CADAC II

Table of content: MRS. CHERYL RENEE HOLLINGSWORTH R.N., CADAC II (NPI 1396183273)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396183273 NPI number — MRS. CHERYL RENEE HOLLINGSWORTH R.N., CADAC II

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLINGSWORTH
Provider First Name:
CHERYL
Provider Middle Name:
RENEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
R.N., CADAC II
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396183273
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
114 N MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOSHEN
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46526-3207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-533-6154
Provider Business Mailing Address Fax Number:
574-534-3951

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
204 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKHART
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46516-3120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-293-1086
Provider Business Practice Location Address Fax Number:
574-522-7461
Provider Enumeration Date:
06/12/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163WA0400X , with the licence number: 28125454A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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