Provider Demographics
NPI:1144283482
Name:JAMES, HOLLY BRUNNER (NP)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:BRUNNER
Last Name:JAMES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:CHRISTINE
Other - Last Name:BRUNNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:127 LONG SANDS RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909
Mailing Address - Country:US
Mailing Address - Phone:207-363-8430
Mailing Address - Fax:207-351-3006
Practice Address - Street 1:127 LONG SANDS RD
Practice Address - Street 2:SUITE 11
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1158
Practice Address - Country:US
Practice Address - Phone:207-363-8430
Practice Address - Fax:207-351-3006
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME041268363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
010467585OtherMACHIGONNE
318710099OtherPRIMECARE MEDICAID
010467585OtherAETNA HMO
010467585OtherAETNA NONHMO
ME318710099Medicaid
P17412OtherHARVARD PILGRIM
NH40Y003456ME01OtherANTHEM BCBS NEW HAMPSHIRE
041288OtherANTHEM BCBS
7525795OtherCIGNA HEALTHCARE
500022130OtherRAILROAD MEDICARE
010467585OtherSTANDARD TAX ID
318710099OtherPRIMECARE MEDICAID
P17412Medicare UPIN