Healthcare Provider Details

I. General information

NPI: 1831559244
Provider Name (Legal Business Name): DEBORAH HOLLY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2016
Last Update Date: 02/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 E. WINROW AVE
FORT HUACHUCA AZ
85613-7079
US

IV. Provider business mailing address

18 DOUGLAS RD
BISBEE AZ
85603-1022
US

V. Phone/Fax

Practice location:
  • Phone: 520-533-9034
  • Fax:
Mailing address:
  • Phone: 520-533-9034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN148204
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: