Provider Demographics
NPI:1710390901
Name:CHADWICK, HOLLY (APN)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:CHADWICK
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:973-656-6280
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:135 NEWTON SPARTA RD
Practice Address - Street 2:SUITE 201
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-2795
Practice Address - Country:US
Practice Address - Phone:973-383-8555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-05
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00501100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily