Healthcare Provider Details

I. General information

NPI: 1336710524
Provider Name (Legal Business Name): HILLARY MARIE HOLMES MYHRE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HILLARY MARIE HOLMES NP-C

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 1ST ST STE A
SAN FRANCISCO CA
94105-2661
US

IV. Provider business mailing address

333 1ST ST STE A
SAN FRANCISCO CA
94105-2661
US

V. Phone/Fax

Practice location:
  • Phone: 415-840-0560
  • Fax: 415-779-8032
Mailing address:
  • Phone: 415-840-0560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2015023222
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2021026639
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: