Provider Demographics
NPI:1053144014
Name:WHITESIDE, HOLLY LEE (RN)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:LEE
Last Name:WHITESIDE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 S 16TH ST
Mailing Address - Street 2:
Mailing Address - City:GROVER BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93433-2245
Mailing Address - Country:US
Mailing Address - Phone:805-473-7040
Mailing Address - Fax:
Practice Address - Street 1:286 S 16TH ST
Practice Address - Street 2:
Practice Address - City:GROVER BEACH
Practice Address - State:CA
Practice Address - Zip Code:93433-2245
Practice Address - Country:US
Practice Address - Phone:805-473-7040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95053005163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health