1619400702 NPI number — HOLLY ESTES M.S., RD, LD, CNSC

Table of content: HOLLY ESTES M.S., RD, LD, CNSC (NPI 1619400702)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619400702 NPI number — HOLLY ESTES M.S., RD, LD, CNSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ESTES
Provider First Name:
HOLLY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S., RD, LD, CNSC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DOETSCH
Provider Other First Name:
HOLLY
Provider Other Middle Name:
ESTES
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1619400702
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
453 W 10TH AVE
Provider Second Line Business Mailing Address:
ATWELL HALL 306
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43210-2205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-688-1755
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
453 W 10TH AVE
Provider Second Line Business Practice Location Address:
ATWELL HALL 306
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43210-2205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-688-1755
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/06/2017

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: 133V00000X , with the licence number:  LD.7080 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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