1609328947 NPI number — HOLLY LAWRENCE FNP

Table of content: HOLLY LAWRENCE FNP (NPI 1609328947)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609328947 NPI number — HOLLY LAWRENCE FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAWRENCE
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:
BUZARD
Provider Other First Name:
HOLLY
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609328947
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 708760
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANDY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84070-8760
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-352-9500
Provider Business Mailing Address Fax Number:
801-352-7976

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 HOSPITAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DU BOIS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15801-1440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-375-6440
Provider Business Practice Location Address Fax Number:
814-375-3081
Provider Enumeration Date:
11/03/2016

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:  SP016761 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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