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Individual

MRS. RENEE KATHLEEN HOLLEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP-C

Contact information

Practice address
7222 ENGLE ROAD, FORT WAYNE, IN 46804-2222
(260) 432-5005
(260) 432-6003
Mailing address
7222 ENGLE ROAD, FORT WAYNE, IN 46804-2222
(260) 432-5005
(260) 432-6003

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71002132A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
20088850
IN
01
P00689114
RAILROAD MEDICARE
Enumeration date
12/21/2007
Last updated
03/14/2012
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