Provider Demographics
NPI:1902104300
Name:HOLLDORF, KARIE MARGARET (NP)
Entity Type:Individual
Prefix:MRS
First Name:KARIE
Middle Name:MARGARET
Last Name:HOLLDORF
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:KARIE
Other - Middle Name:MARGARET
Other - Last Name:BANACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2040 WOODCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-5894
Mailing Address - Country:US
Mailing Address - Phone:847-530-4748
Mailing Address - Fax:
Practice Address - Street 1:14299 OLD NASHVILLE HWY
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6315
Practice Address - Country:US
Practice Address - Phone:847-530-4748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209004397363LF0000X
TN18578363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily