Provider Demographics
NPI:1831124023
Name:MCNAMARA, HOLLY M (ANP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:M
Last Name:MCNAMARA
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 NORTH STATE RD
Mailing Address - Street 2:
Mailing Address - City:BRIARCLIFF MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10510
Mailing Address - Country:US
Mailing Address - Phone:914-762-5810
Mailing Address - Fax:914-762-4223
Practice Address - Street 1:465 NORTH STATE RD
Practice Address - Street 2:
Practice Address - City:BRIARCLIFF MANOR
Practice Address - State:NY
Practice Address - Zip Code:10510
Practice Address - Country:US
Practice Address - Phone:914-762-5810
Practice Address - Fax:914-762-4223
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3016691363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q35480Medicare UPIN
0946G1Medicare ID - Type Unspecified