Provider Demographics
NPI:1689746893
Name:HOLLAR, AUDREY WILLETTE (RN,CLNC)
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:WILLETTE
Last Name:HOLLAR
Suffix:
Gender:F
Credentials:RN,CLNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 LIKENS WAY
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22602-7636
Mailing Address - Country:US
Mailing Address - Phone:540-723-0280
Mailing Address - Fax:540-723-6698
Practice Address - Street 1:158 FRONT ROYAL PIKE STE 200
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22602-4324
Practice Address - Country:US
Practice Address - Phone:540-667-2809
Practice Address - Fax:540-678-9518
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001117631163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice