Provider Demographics
NPI:1790114247
Name:HOLLIS, WILLIAM (RN)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:HOLLIS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 ATKINSON RD
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:NY
Mailing Address - Zip Code:13142-3157
Mailing Address - Country:US
Mailing Address - Phone:315-298-2653
Mailing Address - Fax:
Practice Address - Street 1:396 ATKINSON RD
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:NY
Practice Address - Zip Code:13142-3157
Practice Address - Country:US
Practice Address - Phone:315-298-2653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY630665-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health