Provider Demographics
NPI:1629701230
Name:VIRTUES, HOLLY
Entity Type:Individual
Prefix:MISS
First Name:HOLLY
Middle Name:
Last Name:VIRTUES
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 1:5110 LADE BEACH RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE SUAMICO
Mailing Address - State:WI
Mailing Address - Zip Code:54141-9043
Mailing Address - Country:US
Mailing Address - Phone:920-373-5273
Mailing Address - Fax:
Practice Address - Street 1:5110 LADE BEACH RD
Practice Address - Street 2:
Practice Address - City:LITTLE SUAMICO
Practice Address - State:WI
Practice Address - Zip Code:54141-9043
Practice Address - Country:US
Practice Address - Phone:920-373-5273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program