Healthcare Provider Details

I. General information

NPI: 1467873430
Provider Name (Legal Business Name): HOLLY OBROVAC RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2013
Last Update Date: 12/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 N WHITE SANDS BLVD
ALAMOGORDO NM
88310-6246
US

IV. Provider business mailing address

1900 N WHITE SANDS BLVD
ALAMOGORDO NM
88310-6246
US

V. Phone/Fax

Practice location:
  • Phone: 575-439-4480
  • Fax: 575-439-4494
Mailing address:
  • Phone: 575-439-4480
  • Fax: 575-439-4494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR44166
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: