Provider Demographics
NPI:1881588341
Name:CONN, HOLLY MARIE (NP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:MARIE
Last Name:CONN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:HOLLY
Other - Middle Name:MARIE
Other - Last Name:CONN
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:10211 WEBER ST
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-4633
Mailing Address - Country:US
Mailing Address - Phone:209-200-7808
Mailing Address - Fax:
Practice Address - Street 1:8105 SARATOGA WAY
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-4590
Practice Address - Country:US
Practice Address - Phone:916-983-5771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95035193363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner