MEDICARE: DEBRA S. HOLLISTER DO

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1194780312
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEBRA S. HOLLISTER DO

Provider Business Mailing Address
First Line	:	17 E BROAD ST
Second Line	:
City	:	NEWTON FALLS
State	:	OH
Zip	:	44444-1604
Country	:	US
Telephone Number	:	330-872-1661
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 E BROAD ST
Second Line	:
City	:	NEWTON FALLS
State	:	OH
Zip	:	44444-1604
Country	:	US
Telephone Number	:	330-872-1661
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DEBRA S HOLLISTER
Credential	:	D.O.
Telephone Number	:	330-872-1661

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	10/31/2007

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