# RYAN HOLLEY - MALLO

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1992094403
- **Gender:** Man
- **Credential:** DNP, FNP-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LF0000X | Family Nurse Practitioner | 4704259565 | MI | — |
| 363LP2300X | Primary Care Nurse Practitioner | 4704259565 | MI | Yes |

## Other

- **Enumeration date:** 04/05/2011
- **Last updated:** 03/28/2025