Provider Demographics
NPI:1720586985
Name:DICKINSON, HOLLY ANNETTE (APRN)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:ANNETTE
Last Name:DICKINSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4848 THOMPSON PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80534-6431
Mailing Address - Country:US
Mailing Address - Phone:970-800-4145
Mailing Address - Fax:970-593-5946
Practice Address - Street 1:4848 THOMPSON PKWY STE 300
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:CO
Practice Address - Zip Code:80534-6431
Practice Address - Country:US
Practice Address - Phone:970-800-4145
Practice Address - Fax:970-593-5946
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20000159163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics