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Individual
HOLLY ELLEN MAULT
Active
Individual
HOLLY ELLEN MAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP, FNP
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
304327
NY
363LF0000X
Family Nurse Practitioner
Primary
337423
NY
Other
Enumeration date
10/10/2006
Last updated
10/30/2013
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