Healthcare Provider Details

I. General information

NPI: 1407771058
Provider Name (Legal Business Name): MARIAH CARLY HOLST NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 ELDERBERRY CT
CHESAPEAKE VA
23320-9219
US

IV. Provider business mailing address

709 ELDERBERRY CT
CHESAPEAKE VA
23320-9219
US

V. Phone/Fax

Practice location:
  • Phone: 760-333-6412
  • Fax:
Mailing address:
  • Phone: 760-333-6412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2026056363
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: