Provider Demographics
NPI:1649272162
Name:FERNANDES, HOLLY (RNP)
Entity type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:
Last Name:FERNANDES
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:886 MINERAL SPRING AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-3322
Mailing Address - Country:US
Mailing Address - Phone:401-475-3063
Mailing Address - Fax:401-475-0593
Practice Address - Street 1:886 MINERAL SPRING AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-3322
Practice Address - Country:US
Practice Address - Phone:401-475-3063
Practice Address - Fax:401-475-0593
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP37132363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9003461Medicaid
RIP37326Medicare UPIN
RI9003461Medicaid