Provider Demographics
NPI:1851674808
Name:PRANAAT, HOLLY (CNM)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:PRANAAT
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 LATTIMORE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-4155
Mailing Address - Country:US
Mailing Address - Phone:585-275-7892
Mailing Address - Fax:585-442-6798
Practice Address - Street 1:125 LATTIMORE RD STE 200
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-4155
Practice Address - Country:US
Practice Address - Phone:585-275-7892
Practice Address - Fax:585-442-6798
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001796367A00000X
NY1796367A00000X
OR201250178NP367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500681247Medicaid
OR500681247Medicaid
ORR176069Medicare PIN