Provider Demographics
NPI:1407189764
Name:HOLLY DIMEGLIO, ANP
Entity Type:Organization
Organization Name:HOLLY DIMEGLIO, ANP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMEGLIO
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:907-644-3968
Mailing Address - Street 1:PO BOX 111602
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99511-1602
Mailing Address - Country:US
Mailing Address - Phone:907-644-3968
Mailing Address - Fax:907-644-3969
Practice Address - Street 1:1407 W. 31ST AVE,
Practice Address - Street 2:STE 201
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503
Practice Address - Country:US
Practice Address - Phone:907-644-3968
Practice Address - Fax:907-644-3969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-17
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK928363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMPG0073Medicaid