Provider Demographics
NPI:1356976039
Name:HOLLIST, JULIANNE (NP-C)
Entity type:Individual
Prefix:
First Name:JULIANNE
Middle Name:
Last Name:HOLLIST
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 W WILLOWBROOK DR
Mailing Address - Street 2:STE 103
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-3242
Mailing Address - Country:US
Mailing Address - Phone:208-402-9956
Mailing Address - Fax:
Practice Address - Street 1:55 W WILLOWBROOK DR STE 103
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-3242
Practice Address - Country:US
Practice Address - Phone:208-402-9956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID63993363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health