Provider Demographics
NPI:1477180396
Name:RICHARDSON, HOLLY JOY (DEM)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:JOY
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:DEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:882 W 2800 N
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-8027
Mailing Address - Country:US
Mailing Address - Phone:801-369-2836
Mailing Address - Fax:
Practice Address - Street 1:882 W 2800 N
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-8027
Practice Address - Country:US
Practice Address - Phone:801-369-2836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife