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NPI Code Detail

MEDICARE: AMANDA RAE HOLLORON PMHNP-BC

MEDICARE: AMANDA RAE HOLLORON PMHNP-BC
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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerNUR-APRN-LIC-160743MT

General Provider Information

NPI Number : 1710598073
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA RAE HOLLORON PMHNP-BC
Provider Business Mailing Address
First Line : 2620 CONNERY WAY
Second Line :
City : MISSOULA
State : MT
Zip : 59808-1325
Country : US
Telephone Number : 406-880-9213
Fax Number : 949-864-3190
Provider Business Practice Location Address
First Line : 2620 CONNERY WAY
Second Line :
City : MISSOULA
State : MT
Zip : 59808-1325
Country : US
Telephone Number : 406-880-9213
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2020
Last Update Date : 12/04/2025

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