Provider Demographics
NPI:1114698685
Name:HOLLIS, MATTHEW (RN)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:HOLLIS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 S UNION ST STE 2
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-2844
Mailing Address - Country:US
Mailing Address - Phone:866-610-2273
Mailing Address - Fax:
Practice Address - Street 1:439 S UNION ST STE 2
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-2844
Practice Address - Country:US
Practice Address - Phone:866-610-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN269994163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse