Healthcare Provider Details

I. General information

NPI: 1720586985
Provider Name (Legal Business Name): HOLLY ANNETTE DICKINSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2018
Last Update Date: 01/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4848 THOMPSON PKWY STE 300
JOHNSTOWN CO
80534-6431
US

IV. Provider business mailing address

4848 THOMPSON PKWY STE 300
JOHNSTOWN CO
80534-6431
US

V. Phone/Fax

Practice location:
  • Phone: 970-800-4145
  • Fax: 970-593-5946
Mailing address:
  • Phone: 970-800-4145
  • Fax: 970-593-5946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number20000159
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: