Healthcare Provider Details

I. General information

NPI: 1467289397
Provider Name (Legal Business Name): HOLLY WILBUR APRN, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 PIONEER LN STE B
BISHOP CA
93514-2517
US

IV. Provider business mailing address

153 PIONEER LN STE B
BISHOP CA
93514-2517
US

V. Phone/Fax

Practice location:
  • Phone: 760-873-2602
  • Fax:
Mailing address:
  • Phone: 760-873-2623
  • Fax: 760-873-2626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number95039971
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number0024190731
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: