Provider Demographics
NPI:1477534972
Name:HOLLISTER-MEADOWS, LAURA (FNP-BC)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:HOLLISTER-MEADOWS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:ANN
Other - Last Name:HOLLISTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:301 W POPLAR ST STE 220
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-2800
Mailing Address - Country:US
Mailing Address - Phone:509-897-8300
Mailing Address - Fax:509-897-6066
Practice Address - Street 1:301 W POPLAR ST STE 220
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2800
Practice Address - Country:US
Practice Address - Phone:509-897-8300
Practice Address - Fax:509-897-6066
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007335363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8861064OtherMEDICARE RHC
WA9649039Medicaid
Q71384Medicare UPIN
WAG8861064Medicare Oscar/Certification