Provider Demographics
NPI:1942664867
Name:MICHAELS, HOLLY ANN BISHOP (RD)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:ANN BISHOP
Last Name:MICHAELS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:ANN
Other - Last Name:BISHOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:962 LANE 42 1/2
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82411-9713
Mailing Address - Country:US
Mailing Address - Phone:801-836-3337
Mailing Address - Fax:801-812-5034
Practice Address - Street 1:962 LANE 42 1/2
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WY
Practice Address - Zip Code:82411-9713
Practice Address - Country:US
Practice Address - Phone:801-836-3337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2024-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY288617133V00000X
MTMED-NUTR-LIC-128403133V00000X
UT7109563-4901133V00000X
WY214133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered