Provider Demographics
NPI:1053995688
Name:HACKING, HOLLY C (RN)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:C
Last Name:HACKING
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 W 2450 N
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-9651
Mailing Address - Country:US
Mailing Address - Phone:435-790-3347
Mailing Address - Fax:
Practice Address - Street 1:1611 W 2450 N
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-9651
Practice Address - Country:US
Practice Address - Phone:435-790-3347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT327253-3102163W00000X
UT327253-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse