Healthcare Provider Details

I. General information

NPI: 1154219558
Provider Name (Legal Business Name): HOLLY MAE TREMBLE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 ELECTRIC AVE
PORT HURON MI
48060-8127
US

IV. Provider business mailing address

3111 ELECTRIC AVE
PORT HURON MI
48060-8127
US

V. Phone/Fax

Practice location:
  • Phone: 810-985-8900
  • Fax: 810-987-8391
Mailing address:
  • Phone: 810-985-8900
  • Fax: 810-987-8391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704428275
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: