Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 59037 | ID |
NPI | 1003315789 |
---|---|
Provider Name | Ms. Holly Marie Collins |
First Address | Post Falls, ID 83854-5326 |
Second Address | Coeur D Alene, ID 83815-8600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2018 |
Last Update Date | 04/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003315789 | (05) | ID |