Provider Demographics
NPI:1699827675
Name:GILBERT, HOLLY RAE (NP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:RAE
Last Name:GILBERT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NH
Mailing Address - Zip Code:03833-6012
Mailing Address - Country:US
Mailing Address - Phone:603-642-5440
Mailing Address - Fax:
Practice Address - Street 1:950 WINTER ST
Practice Address - Street 2:SUITE 3800
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1424
Practice Address - Country:US
Practice Address - Phone:781-472-8596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2017-10-02
Deactivation Date:2017-09-26
Deactivation Code:
Reactivation Date:2017-10-02
Provider Licenses
StateLicense IDTaxonomies
MA203819363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology