Healthcare Provider Details

I. General information

NPI: 1417958349
Provider Name (Legal Business Name): HOLLY G DANNEMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 S LOOP RD
EDGEWOOD KY
41017-5446
US

IV. Provider business mailing address

PO BOX 636324
CINCINNATI OH
45263-6324
US

V. Phone/Fax

Practice location:
  • Phone: 859-301-3800
  • Fax: 859-301-3820
Mailing address:
  • Phone: 859-301-3800
  • Fax: 859-301-3820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number37311
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37311
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number37311
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: