MEDICARE: LEE HOLLIDAY FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN039226	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043275324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEE HOLLIDAY FNP

Provider Business Mailing Address
First Line	:	PO BOX 669
Second Line	:
City	:	FLORENCE
State	:	AZ
Zip	:	85132-3012
Country	:	US
Telephone Number	:	520-868-5811
Fax Number	:	520-868-1223

Provider Business Practice Location Address
First Line	:	150 S MAIN ST
Second Line	:
City	:	FLORENCE
State	:	AZ
Zip	:	85132-3012
Country	:	US
Telephone Number	:	520-868-5811
Fax Number	:	520-868-1223

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	02/15/2012

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