Provider Demographics
NPI:1922626068
Name:DUDDY, HOLLY GRACE (MS, RN, FNP-C)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:GRACE
Last Name:DUDDY
Suffix:
Gender:F
Credentials:MS, RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5557 W 4100 S
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-4629
Mailing Address - Country:US
Mailing Address - Phone:801-966-1118
Mailing Address - Fax:
Practice Address - Street 1:5557 W 4100 S
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-4629
Practice Address - Country:US
Practice Address - Phone:801-966-1118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAF07200442363LF0000X
UT12115763-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily