Provider Demographics
NPI:1508092370
Name:BAUS, HOLLY ANN (RN)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:ANN
Last Name:BAUS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9614 BRADDOCK RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-2501
Mailing Address - Country:US
Mailing Address - Phone:571-332-6077
Mailing Address - Fax:
Practice Address - Street 1:9614 BRADDOCK RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22032-2501
Practice Address - Country:US
Practice Address - Phone:571-332-6077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-06
Last Update Date:2009-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001214060163W00000X
DCRN1015326163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse