Provider Demographics
NPI:1104185727
Name:DURNING, HOLLY LYNN (LAC)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:LYNN
Last Name:DURNING
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:LYNN
Other - Last Name:NORTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50 HILL ST # 368
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-5317
Mailing Address - Country:US
Mailing Address - Phone:631-332-8856
Mailing Address - Fax:
Practice Address - Street 1:20 HAMPTON RD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-4959
Practice Address - Country:US
Practice Address - Phone:631-332-8856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004808171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist