Provider Demographics
NPI:1093115727
Name:RICKER, HOLLIS ANNE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:HOLLIS
Middle Name:ANNE
Last Name:RICKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:RICKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 413033
Mailing Address - Street 2:BONE MARROW TRANSPLANT, CLINIC 2C
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84141-3033
Mailing Address - Country:US
Mailing Address - Phone:801-213-3900
Mailing Address - Fax:
Practice Address - Street 1:2000 CIRCLE OF HOPE DR
Practice Address - Street 2:BONE MARROW TRANSPLANT, CLINIC 2C
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84112-5550
Practice Address - Country:US
Practice Address - Phone:801-585-2626
Practice Address - Fax:801-581-4115
Is Sole Proprietor?:No
Enumeration Date:2014-08-29
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9139148-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant