Provider Demographics
NPI:1043851124
Name:HOLLERN, HARLEIGH (PA-C)
Entity type:Individual
Prefix:
First Name:HARLEIGH
Middle Name:
Last Name:HOLLERN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:496 E GRANT ST
Mailing Address - Street 2:
Mailing Address - City:EAST PALESTINE
Mailing Address - State:OH
Mailing Address - Zip Code:44413-2304
Mailing Address - Country:US
Mailing Address - Phone:330-921-8851
Mailing Address - Fax:
Practice Address - Street 1:225 E STATE ROUTE 14 STE 102
Practice Address - Street 2:
Practice Address - City:COLUMBIANA
Practice Address - State:OH
Practice Address - Zip Code:44408-8490
Practice Address - Country:US
Practice Address - Phone:330-965-5046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA060809363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical