Provider Demographics
NPI:1518056357
Name:KAUFMAN, HOLLIE RYNERSON (ARNP)
Entity Type:Individual
Prefix:
First Name:HOLLIE
Middle Name:RYNERSON
Last Name:KAUFMAN
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 1:243511 WEST HWY 101
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98363-9472
Mailing Address - Country:US
Mailing Address - Phone:360-452-6252
Mailing Address - Fax:360-452-6274
Practice Address - Street 1:243511 WEST HWY 101
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98363-9472
Practice Address - Country:US
Practice Address - Phone:360-452-6252
Practice Address - Fax:360-452-6274
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-006133363LF0000X
WAAP30007743363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9653577Medicaid
WA00421026OtherRAILROAD MEDICARE
WA0222708OtherLABOR AND INDUSTRIES
K33667OtherPROVIDER NUMBER
WA8867595OtherMEDICARE ID
WA9653577Medicaid