Healthcare Provider Details

I. General information

NPI: 1083952808
Provider Name (Legal Business Name): MARY HOLLERAN PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2013
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 SCOTLAND ST
HINGHAM MA
02043-3932
US

IV. Provider business mailing address

39 SCOTLAND ST
HINGHAM MA
02043-3932
US

V. Phone/Fax

Practice location:
  • Phone: 301-257-2522
  • Fax:
Mailing address:
  • Phone: 301-257-2522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN263545
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: