Provider Demographics
NPI:1679702237
Name:SEVERSON, HOLLY (RN)
Entity type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:
Last Name:SEVERSON
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 1:1950 ALAMEDA DE LAS PULGAS
Mailing Address - Street 2:SUITE 157
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-1222
Mailing Address - Country:US
Mailing Address - Phone:650-573-2996
Mailing Address - Fax:650-573-2841
Practice Address - Street 1:1950 ALAMEDA DE LAS PULGAS
Practice Address - Street 2:SUITE 157
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1222
Practice Address - Country:US
Practice Address - Phone:650-573-2996
Practice Address - Fax:650-573-2841
Is Sole Proprietor?:No
Enumeration Date:2009-07-03
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA672272163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse