Provider Demographics
NPI:1225003601
Name:SALLEY, HOLLY ANN (CRNA)
Entity Type:Individual
Prefix:PROF
First Name:HOLLY
Middle Name:ANN
Last Name:SALLEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2570 HAYMAKER RD
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3513
Mailing Address - Country:US
Mailing Address - Phone:412-578-5323
Mailing Address - Fax:412-578-4981
Practice Address - Street 1:2570 HAYMAKER RD
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3513
Practice Address - Country:US
Practice Address - Phone:412-578-5323
Practice Address - Fax:412-578-4981
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN289683L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001942247Medicaid
PA010994FEVMedicare ID - Type Unspecified