=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669471223
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PETER R HOLLEY NP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2005
-----------------------------------------------------
Last Update Date | 01/24/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | UNIT 6180 BOX 0014
-----------------------------------------------------
City | DPO
-----------------------------------------------------
State | AE
-----------------------------------------------------
Zip | 09806-9997
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-663-1662
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2401 E ST NW SA-1, 2ND FLOOR
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20522-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-663-1662
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 2802
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------