Provider Demographics
NPI:1831366236
Name:HOLLENBECK, ANNETTE M (NP)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:M
Last Name:HOLLENBECK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:600 N MOUNTAIN AVE
Mailing Address - Street 2:STE A100
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4359
Mailing Address - Country:US
Mailing Address - Phone:909-981-8599
Mailing Address - Fax:909-981-5441
Practice Address - Street 1:600 N MOUNTAIN AVE
Practice Address - Street 2:STE A100
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4359
Practice Address - Country:US
Practice Address - Phone:909-981-8599
Practice Address - Fax:909-981-5441
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA379819363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily