1497749147 NPI number — HOLLY OLIVEIRA FNP

Table of content: HOLLY OLIVEIRA FNP (NPI 1497749147)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497749147 NPI number — HOLLY OLIVEIRA FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLIVEIRA
Provider First Name:
HOLLY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WELLMAN
Provider Other First Name:
HOLLY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1497749147
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1358
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76241-1358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-612-5562
Provider Business Mailing Address Fax Number:
940-665-6201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 KIOWA DR W
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
LAKE KIOWA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76240-9584
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-612-5562
Provider Business Practice Location Address Fax Number:
940-665-6201
Provider Enumeration Date:
09/08/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  564679 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 141099502 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".