Provider Demographics
NPI:1255149365
Name:HOLLIS, AMI LEAH (RN, CLT)
Entity type:Individual
Prefix:
First Name:AMI
Middle Name:LEAH
Last Name:HOLLIS
Suffix:
Gender:F
Credentials:RN, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 MESQUITE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5894
Mailing Address - Country:US
Mailing Address - Phone:928-248-0525
Mailing Address - Fax:
Practice Address - Street 1:2035 MESQUITE AVE STE C
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5894
Practice Address - Country:US
Practice Address - Phone:928-248-0525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN103386163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse