Provider Demographics
NPI:1669471223
Name:HOLLEY, PETER R (NP)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:R
Last Name:HOLLEY
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 E ST NW
Mailing Address - Street 2:SA-1, 2ND FLOOR
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20522-0001
Mailing Address - Country:US
Mailing Address - Phone:202-663-1662
Mailing Address - Fax:
Practice Address - Street 1:UNIT 6180
Practice Address - Street 2:BOX 0014
Practice Address - City:DPO
Practice Address - State:AE
Practice Address - Zip Code:09806-9997
Practice Address - Country:US
Practice Address - Phone:202-663-1662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2802363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAS37948Medicare UPIN