Provider Demographics
NPI:1952025736
Name:DEWITT, HOLLY ANN (DACM)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:ANN
Last Name:DEWITT
Suffix:
Gender:F
Credentials:DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4601 E SKYLINE DR APT 1411
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-1662
Mailing Address - Country:US
Mailing Address - Phone:913-548-8201
Mailing Address - Fax:
Practice Address - Street 1:2034 LAKE TAHOE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-6499
Practice Address - Country:US
Practice Address - Phone:530-541-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ011376171100000X
CA19119171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist