Provider Demographics
NPI:1144236266
Name:NGUYEN, HOLLY T (PAC)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 CONCORD ST
Mailing Address - Street 2:STE C
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887
Mailing Address - Country:US
Mailing Address - Phone:978-988-9700
Mailing Address - Fax:978-988-9701
Practice Address - Street 1:64 CONCORD ST
Practice Address - Street 2:STE C
Practice Address - City:WILMINGTON
Practice Address - State:MA
Practice Address - Zip Code:01887
Practice Address - Country:US
Practice Address - Phone:978-988-9700
Practice Address - Fax:978-988-9701
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1035363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMN0377881JOtherCONTROL LIC
MA1035OtherLICENSE
043480187OtherTAX ID
043480187OtherTAX ID
MAMN0377881JOtherCONTROL LIC