Provider Demographics
NPI:1669406450
Name:WHITE, HOLLY LYNN (CNM)
Entity type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:LYNN
Last Name:WHITE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:417 PROSPECT PL APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-4133
Mailing Address - Country:US
Mailing Address - Phone:718-399-3339
Mailing Address - Fax:
Practice Address - Street 1:274 MADISON AVE RM 1501
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0701
Practice Address - Country:US
Practice Address - Phone:212-203-1773
Practice Address - Fax:646-665-4427
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY403794363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP59104Medicare UPIN
NYMEM821Medicare ID - Type Unspecified