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General NPI Number Information
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NPI Number | 1881857167
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Entity Type | Individual
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Provider Name | HOLLY LYNN GOMEZ-LEVINE APRN, CNP
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Gender | Female
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Dates
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Enumeration Date | 07/07/2008
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Last Update Date | 05/22/2019
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Provider Practice Location Address
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Address Line | 3500 TOWER AVE
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City | SUPERIOR
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State | WI
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Zip | 54880-4491
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Country | US
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Telephone | 715-817-7100
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Fax | 406-457-8992
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Provider Business Mailing Address
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Address Line | 1702 UNIVERSITY DR S
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City | FARGO
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State | ND
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Zip | 58103-4940
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Country | US
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Telephone |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 100926
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 7182-33
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License Number State | WI
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