Provider Demographics
NPI:1619400702
Name:ESTES, HOLLY (MS, RD, LD, CNSC)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:ESTES
Suffix:
Gender:F
Credentials:MS, RD, LD, CNSC
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:ESTES
Other - Last Name:DOETSCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:453 W 10TH AVE
Mailing Address - Street 2:ATWELL HALL 306
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210-2205
Mailing Address - Country:US
Mailing Address - Phone:614-688-1755
Mailing Address - Fax:
Practice Address - Street 1:453 W 10TH AVE
Practice Address - Street 2:ATWELL HALL 306
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-2205
Practice Address - Country:US
Practice Address - Phone:614-688-1755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.7080133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered