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General NPI Number Information
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NPI Number | 1245840131
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Entity Type | Individual
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Provider Name | MEGAN HOLLISTER
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Gender | Female
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Dates
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Enumeration Date | 08/05/2020
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Last Update Date | 08/16/2025
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Provider Practice Location Address
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Address Line | 5 MASONIC AVE
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City | CAMDEN
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State | NY
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Zip | 13316-1234
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Country | US
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Telephone | 315-245-3192
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Fax | 315-245-3195
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Provider Business Mailing Address
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Address Line | 245 AVERY LN
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City | ROME
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State | NY
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Zip | 13441-4237
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Country | US
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Telephone | 315-337-1200
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F346300
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License Number State | NY
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