Provider Demographics
NPI:1740635077
Name:CONOVER, HOLLY (CNP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:CONOVER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:VACULIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:3125 TRANSVERSE DR RM 12
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-8008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3125 TRANSVERSE DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-8008
Practice Address - Country:US
Practice Address - Phone:419-383-6843
Practice Address - Fax:419-383-3338
Is Sole Proprietor?:No
Enumeration Date:2016-04-23
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.020095363LG0600X
OH377956363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0237656Medicaid