Provider Demographics
NPI:1720754807
Name:SIMES, HOLLIE LOUISE (APRN)
Entity Type:Individual
Prefix:MISS
First Name:HOLLIE
Middle Name:LOUISE
Last Name:SIMES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 SE UGLOW AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-2645
Mailing Address - Country:US
Mailing Address - Phone:503-623-8376
Mailing Address - Fax:
Practice Address - Street 1:1000 SE UGLOW AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-2645
Practice Address - Country:US
Practice Address - Phone:503-623-8376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-19
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3016516363LF0000X
OR202112422NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty