Healthcare Provider Details

I. General information

NPI: 1295408581
Provider Name (Legal Business Name): HOLLY NILSSON CRNP-FAMILY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2021
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7250 PARKWAY DRIVE SUITE 500
HANOVER MD
21076
US

IV. Provider business mailing address

7250 PARKWAY DRIVE SUITE 500
HANOVER MD
21076
US

V. Phone/Fax

Practice location:
  • Phone: 443-949-0814
  • Fax:
Mailing address:
  • Phone: 443-949-0814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR170648
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: