Provider Demographics
NPI:1619721958
Name:MATTHEWS, HOLLY
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:MATTHEWS
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 1:9730 N HIGHWAY 38
Mailing Address - Street 2:
Mailing Address - City:DEWEYVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84309-9728
Mailing Address - Country:US
Mailing Address - Phone:435-279-0528
Mailing Address - Fax:
Practice Address - Street 1:9730 N HIGHWAY 38
Practice Address - Street 2:
Practice Address - City:DEWEYVILLE
Practice Address - State:UT
Practice Address - Zip Code:84309-9728
Practice Address - Country:US
Practice Address - Phone:435-279-0528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13072796-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse