Individual
HOLLY A FAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3303 S BOND AVE, PORTLAND, OR 97239-4501
(503) 494-6594
(503) 494-5385
Mailing address
1400 SW 5TH AVE STE 500, PORTLAND, OR 97201-5537
(866) 617-6855
(503) 346-8015
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
200840955RN
OR
363L00000X
Nurse Practitioner
201908142NP-PP
OR
363LF0000X
Family Nurse Practitioner
Primary
201908142NP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500769164
—
OR
Enumeration date
08/26/2019
Last updated
09/27/2023
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