Provider Demographics
NPI:1114954864
Name:HOLLORAN, CYNTHIA L (NP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:HOLLORAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 SWIFTWATER RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WOODSVILLE
Mailing Address - State:NH
Mailing Address - Zip Code:03785-1447
Mailing Address - Country:US
Mailing Address - Phone:603-747-2900
Mailing Address - Fax:603-747-2992
Practice Address - Street 1:79 SWIFTWATER RD
Practice Address - Street 2:SUITE 2
Practice Address - City:WOODSVILLE
Practice Address - State:NH
Practice Address - Zip Code:03785-1447
Practice Address - Country:US
Practice Address - Phone:603-747-2900
Practice Address - Fax:603-747-2992
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0291632305363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH23YPO7158NH01OtherANTHEM BCBS
P00213176OtherRRMCR
VT68015OtherVT BCBS
VTONP1707Medicaid
PA51422OtherCIGNA PA
VT4124988OtherMVP
NH30340252Medicaid
S75996Medicare UPIN
NHUX6466Medicare PIN