Basic Information
| Provider Information | |||||||||
| NPI: | 1770021933 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUNHAM | ||||||||
| FirstName: | HOLLI | ||||||||
| MiddleName: | EDEN | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 CALDWELL RD | ||||||||
| Address2: | |||||||||
| City: | LUCASVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456488346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403527164 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12340 STATE ROUTE 104 | ||||||||
| Address2: | |||||||||
| City: | WAVERLY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456908968 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7409415180 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2017 | ||||||||
| LastUpdateDate: | 12/29/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN.341688 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.