Provider Demographics
NPI:1053758813
Name:STEPHENS, HOLLY L (RN)
Entity type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:L
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:HOLLY
Other - Middle Name:L
Other - Last Name:CHRISTENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12565 W CENTER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-3802
Mailing Address - Country:US
Mailing Address - Phone:402-342-5566
Mailing Address - Fax:402-342-0034
Practice Address - Street 1:12565 W CENTER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3802
Practice Address - Country:US
Practice Address - Phone:402-342-5566
Practice Address - Fax:402-342-0034
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA128355163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse