Provider Demographics
NPI:1376360255
Name:KHAN, HOLLY WISE (NP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:WISE
Last Name:KHAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 KENDALL ST APT 1506
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02142-1184
Mailing Address - Country:US
Mailing Address - Phone:203-940-0951
Mailing Address - Fax:
Practice Address - Street 1:250 KENDALL ST APT 1506
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02142-1184
Practice Address - Country:US
Practice Address - Phone:203-940-0951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2359611363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner