Provider Demographics
NPI:1619684008
Name:GAZY, HOLLY
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:GAZY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6040 S 3RD RD
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-8904
Mailing Address - Country:US
Mailing Address - Phone:406-570-3512
Mailing Address - Fax:406-219-2555
Practice Address - Street 1:6040 S 3RD RD
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-8904
Practice Address - Country:US
Practice Address - Phone:406-570-3512
Practice Address - Fax:406-219-2555
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT000000004253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No253Z00000XAgenciesIn Home Supportive Care