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NPI Code Detail

MEDICARE: HOLLY DEEANN PETERSON RN

MEDICARE: HOLLY DEEANN PETERSON RN
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
1163W00000XRegistered Nurse834115NV

General Provider Information

NPI Number : 1093674202
Entity Type Code : Individual
Provider Name (Legal Business Name) : HOLLY DEEANN PETERSON RN
Provider Business Mailing Address
First Line : 9005 BIG PLANTATION AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89143-1119
Country : US
Telephone Number : 702-355-8332
Fax Number :
Provider Business Practice Location Address
First Line : 3930 HOWARD HUGHES PKWY STE 300
Second Line :
City : LAS VEGAS
State : NV
Zip : 89169-0946
Country : US
Telephone Number : 702-560-2192
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/21/2026
Last Update Date : 01/21/2026

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