Provider Demographics
NPI:1083370217
Name:HILL, HOLLY (RD)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:HILL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9820 N DEEP CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILLS
Mailing Address - State:UT
Mailing Address - Zip Code:84062-8981
Mailing Address - Country:US
Mailing Address - Phone:317-258-7217
Mailing Address - Fax:
Practice Address - Street 1:9820 N DEEP CREEK DR
Practice Address - Street 2:
Practice Address - City:CEDAR HILLS
Practice Address - State:UT
Practice Address - Zip Code:84062-8981
Practice Address - Country:US
Practice Address - Phone:317-258-7217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10392997-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered