Provider Demographics
NPI:1922064088
Name:ARDINGER, HOLLY HUTCHISON (MD)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:HUTCHISON
Last Name:ARDINGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12404 KALLGREN RD NE
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-3328
Mailing Address - Country:US
Mailing Address - Phone:913-523-5626
Mailing Address - Fax:
Practice Address - Street 1:12404 KALLGREN RD NE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-3328
Practice Address - Country:US
Practice Address - Phone:913-523-5626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2018-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60637590207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208481614Medicaid
KS100125330BMedicaid
A02680Medicare UPIN