Provider Demographics
NPI:1366542235
Name:HOLLIS, GENEVIEVE ANN (CRNP)
Entity type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:ANN
Last Name:HOLLIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:GENEVIEVE
Other - Middle Name:ANN
Other - Last Name:GORMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:3400 CIVIC CENTER BLVD
Mailing Address - Street 2:PCAM 2 WEST ADIMINSTRATIVE OFFICE RAD/ONC
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5127
Mailing Address - Country:US
Mailing Address - Phone:215-662-2428
Mailing Address - Fax:215-349-5923
Practice Address - Street 1:3400 CIVIC CENTER BLVD
Practice Address - Street 2:CONCOURSE LEVEL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5127
Practice Address - Country:US
Practice Address - Phone:215-662-2428
Practice Address - Fax:215-349-5923
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008113363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner