Provider Demographics
NPI:1447977723
Name:HOLLEY, LIBBY ANNETTE (RN)
Entity type:Individual
Prefix:
First Name:LIBBY
Middle Name:ANNETTE
Last Name:HOLLEY
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 1:4459 TAR HILL DRIVE
Mailing Address - Street 2:
Mailing Address - City:PINK HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28572
Mailing Address - Country:US
Mailing Address - Phone:866-768-8479
Mailing Address - Fax:
Practice Address - Street 1:4459 TAR HILL DRIVE
Practice Address - Street 2:
Practice Address - City:PINK HILL
Practice Address - State:NC
Practice Address - Zip Code:28572
Practice Address - Country:US
Practice Address - Phone:866-768-8479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001161832163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty