Healthcare Provider Details

I. General information

NPI: 1831010826
Provider Name (Legal Business Name): HOLLY ILG DNP-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1244 36TH AVE
FOREST GROVE OR
97116-5025
US

IV. Provider business mailing address

1244 36TH AVE
FOREST GROVE OR
97116-5025
US

V. Phone/Fax

Practice location:
  • Phone: 360-624-3325
  • Fax:
Mailing address:
  • Phone: 360-624-3325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number201340602RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: