MEDICARE: DEBORAH FAYE HOLLINGSWORTH MSN, FNP-C

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	N-33941, NP-701A	ID

General Provider Information

NPI Number	:	1871591339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH FAYE HOLLINGSWORTH MSN, FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 1015
Second Line	:
City	:	EMMETT
State	:	ID
Zip	:	83617-1015
Country	:	US
Telephone Number	:	208-365-0890
Fax Number	:	208-365-0950

Provider Business Practice Location Address
First Line	:	3777 VAN DUSSEN RD
Second Line	:
City	:	EMMETT
State	:	ID
Zip	:	83617-9549
Country	:	US
Telephone Number	:	208-365-0890
Fax Number	:	208-365-0950

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

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	07/08/2007

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