Glenda Joann Hollis, LPN
Individual provider Active NPI Licensed Practical Nurse · Avera, GA
NPI 1215326871 · NPPES record last updated Jan 21, 2015
Key facts
- NPI
- 1215326871
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- LPN050212 (GA)
- Practice address
- Sandvalley Road 10596
Avera, GA 30803 - Phone
- (912) 245-4504
- NPI assigned
- Jan 20, 2015
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPN050212 | GA | MD | Licensed Practical Nurse |
| 055768176 | GA | MD | Driver |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | LPN050212 | GA | Yes |
| Driver | 172A00000X | 055768176 | GA | |
| Adult Companion | 372600000X | |||
| Home Health Aide | 374U00000X |
Addresses
Primary practice location
Sandvalley Road 10596
Avera, GA 30803
Mailing address
P.O. Box 85
Kingdom Kare & Komfort
Wrens, GA 30833
Phone (912) 245-4504
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 21, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.