Provider Demographics
NPI:1437227113
Name:WOLLASTON, HOLLY ANN (ARNP)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:ANN
Last Name:WOLLASTON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 NE 130TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-4034
Mailing Address - Country:US
Mailing Address - Phone:206-361-7678
Mailing Address - Fax:
Practice Address - Street 1:325 9TH AVE # 359776
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2420
Practice Address - Country:US
Practice Address - Phone:206-731-2195
Practice Address - Fax:206-731-4350
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30000306363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP30000306OtherARNP LICENSE
WAS71530Medicare UPIN
WA9607052Medicare ID - Type Unspecified