Provider Demographics
NPI:1093710105
Name:RAIMONDI, HOLLY ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:ELIZABETH
Last Name:RAIMONDI
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:1400 S LAKE PARK AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-6791
Mailing Address - Country:US
Mailing Address - Phone:219-947-6122
Mailing Address - Fax:219-947-6045
Practice Address - Street 1:1400 S LAKE PARK AVE
Practice Address - Street 2:STE 200
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-6791
Practice Address - Country:US
Practice Address - Phone:219-947-6122
Practice Address - Fax:219-947-6045
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN10000619A363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP69779Medicare UPIN
P69779Medicare UPIN