Provider Demographics
NPI:1609246040
Name:BENT, HOLLY MICHELLE (NP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:MICHELLE
Last Name:BENT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51-338 KAMEHAMEHA HWY
Mailing Address - Street 2:
Mailing Address - City:KAAAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96730-9808
Mailing Address - Country:US
Mailing Address - Phone:808-387-8699
Mailing Address - Fax:
Practice Address - Street 1:51-338 KAMEHAMEHA HWY
Practice Address - Street 2:
Practice Address - City:KAAAWA
Practice Address - State:HI
Practice Address - Zip Code:96730-9808
Practice Address - Country:US
Practice Address - Phone:808-387-8699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-28
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-1982363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily