Healthcare Provider Details

I. General information

NPI: 1093180614
Provider Name (Legal Business Name): HOLLY MASSEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2015
Last Update Date: 12/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1642 S PRIEST DR BLDG 6, SUITE 101
TEMPE AZ
85281-6204
US

IV. Provider business mailing address

3003 N CENTRAL AVE SUITE 200
PHOENIX AZ
85012-2902
US

V. Phone/Fax

Practice location:
  • Phone: 480-929-5100
  • Fax: 602-302-7925
Mailing address:
  • Phone: 602-302-7715
  • Fax: 602-302-6973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN142698
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: