Provider Demographics
NPI:1942700711
Name:GOHR, HOLLIE (RN, FNP)
Entity Type:Individual
Prefix:
First Name:HOLLIE
Middle Name:
Last Name:GOHR
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 LAKES EDGE DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-5230
Mailing Address - Country:US
Mailing Address - Phone:586-242-1160
Mailing Address - Fax:
Practice Address - Street 1:10090 E LIPPINCOTT BLVD
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-9151
Practice Address - Country:US
Practice Address - Phone:810-653-1130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-18
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704240623163W00000X
MIF12170696363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse