MEDICARE: FATOU FYE HOLLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R175346	MD
2	163W00000X	Registered Nurse	RN1009490	DC

General Provider Information

NPI Number	:	1588223507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FATOU FYE HOLLEY

Provider Business Mailing Address
First Line	:	4560 CRAIN HWY
Second Line	:
City	:	WHITE PLAINS
State	:	MD
Zip	:	20695-3084
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4560 CRAIN HWY
Second Line	:
City	:	WHITE PLAINS
State	:	MD
Zip	:	20695-3084
Country	:	US
Telephone Number	:	301-917-5733
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2019
Last Update Date	:	09/02/2025

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Directions to “ FATOU FYE HOLLEY ” Practice Location

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