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General NPI Number Information
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NPI Number | 1649240938
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Entity Type | Individual
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Provider Name | HOLLY J LAGO C-FNP
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Gender | Female
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Dates
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Enumeration Date | 01/26/2006
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 1940 W INDIAN SCHOOL RD STE 1
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City | PHOENIX
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State | AZ
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Zip | 85015-5112
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Country | US
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Telephone | 602-782-1880
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 746093
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City | ATLANTA
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State | GA
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Zip | 30374-6093
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Country | US
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Telephone | 312-733-9730
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | R134082-4
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2020040251
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 80303
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License Number State | KS
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