Provider Demographics
NPI:1841516150
Name:FAVERO, HOLLY JEAN (ACNP-BC)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:JEAN
Last Name:FAVERO
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14555 LEVAN RD
Mailing Address - Street 2:SUITE E-412
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-5083
Mailing Address - Country:US
Mailing Address - Phone:734-655-2700
Mailing Address - Fax:734-655-4254
Practice Address - Street 1:14555 LEVAN RD
Practice Address - Street 2:SUITE E-412
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-5083
Practice Address - Country:US
Practice Address - Phone:734-655-2700
Practice Address - Fax:734-655-4254
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704166625363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care