Healthcare Provider Details

I. General information

NPI: 1861788929
Provider Name (Legal Business Name): HOLLY JEAN FIKE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 09/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 W TAFT RD
LIVERPOOL NY
13088-3807
US

IV. Provider business mailing address

5100 W TAFT RD
LIVERPOOL NY
13088-3807
US

V. Phone/Fax

Practice location:
  • Phone: 315-452-2828
  • Fax: 315-452-2870
Mailing address:
  • Phone: 315-452-2828
  • Fax: 315-452-2870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF336838
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: