Individual
JEAN L. HOLLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
611 W. PARK ST., NEPHROLOGY, URBANA, IL 61801-2500
(217) 383-3605
(217) 383-2704
Mailing address
611 W. PARK ST., BWPC, URBANA, IL 61801-2500
(217) 383-6792
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
0101231892
VA
207RN0300X
Nephrology Physician
Primary
03606251
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005865051
—
VA
Enumeration date
11/07/2006
Last updated
10/08/2015
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