Provider Demographics
NPI:1427034909
Name:TODD, HOLLY L (WHNP)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:L
Last Name:TODD
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:KORICA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHNP
Mailing Address - Street 1:2702 NORTH 3RD STREET
Mailing Address - Street 2:SUITE 4020
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-4608
Mailing Address - Country:US
Mailing Address - Phone:602-323-3344
Mailing Address - Fax:602-323-3496
Practice Address - Street 1:635 EAST BASELINE ROAD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-6551
Practice Address - Country:US
Practice Address - Phone:602-243-7277
Practice Address - Fax:602-243-5019
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP0241363LX0001X
AZRN075083363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ753774Medicaid
AZP40036Medicare UPIN
AZ753774Medicaid
133735Medicare PIN