Provider Demographics
NPI:1134090624
Name:DEFFERT, HOLLY
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:DEFFERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2885 SE GRAPEVINE RD
Mailing Address - Street 2:
Mailing Address - City:IDLEDALE
Mailing Address - State:CO
Mailing Address - Zip Code:80453-5014
Mailing Address - Country:US
Mailing Address - Phone:720-240-1360
Mailing Address - Fax:
Practice Address - Street 1:2885 SE GRAPEVINE RD
Practice Address - Street 2:
Practice Address - City:IDLEDALE
Practice Address - State:CO
Practice Address - Zip Code:80453-5014
Practice Address - Country:US
Practice Address - Phone:720-240-1360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0191644163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency