Basic Information
| Provider Information | |||||||||
| NPI: | 1821638057 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLSTEIN | ||||||||
| FirstName: | LEEVETTA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | APRN-CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 462 2ND ST | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 251301414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046870721 | ||||||||
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| Practice Location | |||||||||
| Address1: | 260 MALL RD | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 250534000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043691385 | ||||||||
| FaxNumber: | 3043699684 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2020 | ||||||||
| LastUpdateDate: | 01/15/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 105405 | WV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.