Provider Demographics
NPI:1043381437
Name:LARRABEE, HOLLYNN LEE (MD)
Entity Type:Individual
Prefix:
First Name:HOLLYNN
Middle Name:LEE
Last Name:LARRABEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HOLLYNN
Other - Middle Name:LEE
Other - Last Name:CUNNINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 30180
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84130-0180
Mailing Address - Country:US
Mailing Address - Phone:304-216-7639
Mailing Address - Fax:
Practice Address - Street 1:5121 S COTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5701
Practice Address - Country:US
Practice Address - Phone:801-507-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-086209207P00000X
UT9421851-1205207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVLA6037351Medicare PIN
WVCA7030OtherRAILROAD MEDICARE GROUP #
OHLA4171401Medicare ID - Type Unspecified
WVP00623108OtherRAILROAD MEDICARE
OHI44263Medicare UPIN
WV3810012657Medicaid