Provider Demographics
NPI:1487848289
Name:HOLLIDAY, MAXIMILLIAN (ARNP)
Entity Type:Individual
Prefix:
First Name:MAXIMILLIAN
Middle Name:
Last Name:HOLLIDAY
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 E NEIDER AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-6007
Mailing Address - Country:US
Mailing Address - Phone:208-930-4944
Mailing Address - Fax:888-443-4939
Practice Address - Street 1:611 E SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2732
Practice Address - Country:US
Practice Address - Phone:208-930-4944
Practice Address - Fax:888-443-4939
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3023212363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily