Provider Demographics
NPI:1710605985
Name:GRACE, HOLLY ERIN
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:ERIN
Last Name:GRACE
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 1:2700 N A W GRIMES BLVD APT 922
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-3436
Mailing Address - Country:US
Mailing Address - Phone:214-621-3952
Mailing Address - Fax:
Practice Address - Street 1:200 BOBCAT WAY
Practice Address - Street 2:WILLOW HALL 110
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665
Practice Address - Country:US
Practice Address - Phone:512-716-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program