Provider Demographics
NPI:1982245965
Name:GONGAWARE, HOLLY LINN (CRNP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:LINN
Last Name:GONGAWARE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5318 RANALLI DR
Mailing Address - Street 2:
Mailing Address - City:GIBSONIA
Mailing Address - State:PA
Mailing Address - Zip Code:15044-9653
Mailing Address - Country:US
Mailing Address - Phone:724-449-9355
Mailing Address - Fax:724-449-2727
Practice Address - Street 1:5318 RANALLI DR
Practice Address - Street 2:
Practice Address - City:GIBSONIA
Practice Address - State:PA
Practice Address - Zip Code:15044-9653
Practice Address - Country:US
Practice Address - Phone:724-449-9355
Practice Address - Fax:724-449-2727
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020835363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner