Provider Demographics
NPI:1861024226
Name:STAIR-GOSHU, HOLLY (FNP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:STAIR-GOSHU
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2019 AUTUMN FERN DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-6673
Mailing Address - Country:US
Mailing Address - Phone:832-754-3677
Mailing Address - Fax:
Practice Address - Street 1:25722 KINGSLAND BLVD STE 111
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-2642
Practice Address - Country:US
Practice Address - Phone:281-391-0190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138485363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily