Provider Demographics
NPI:1073940565
Name:HURD, HOLLY A (RN)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:A
Last Name:HURD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:STILLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1039 ISLINGTON ST
Mailing Address - Street 2:SUITE 16
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4262
Mailing Address - Country:US
Mailing Address - Phone:603-431-0505
Mailing Address - Fax:603-431-2228
Practice Address - Street 1:1039 ISLINGTON ST
Practice Address - Street 2:SUITE 16
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4262
Practice Address - Country:US
Practice Address - Phone:603-431-0505
Practice Address - Fax:603-431-2228
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH039394-21163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse