Provider Demographics
NPI:1932538683
Name:HOLLIS, RYAN LEE (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:LEE
Last Name:HOLLIS
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:3500 FRANCISCAN WAY
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-0021
Practice Address - Country:US
Practice Address - Phone:317-528-4800
Practice Address - Fax:219-877-2000
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209027989363LF0000X
IN71004693A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily