Provider Demographics
NPI:1639491798
Name:MORALES, HOLLY MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:MARIE
Last Name:MORALES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:MARIE
Other - Last Name:SQUIBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:101 WILLMAR AVE SW
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-3556
Mailing Address - Country:US
Mailing Address - Phone:320-231-5079
Mailing Address - Fax:320-231-5067
Practice Address - Street 1:101 WILLMAR AVE SW
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-3556
Practice Address - Country:US
Practice Address - Phone:320-231-5079
Practice Address - Fax:320-231-5067
Is Sole Proprietor?:No
Enumeration Date:2010-02-17
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
MN10706363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant