Provider Demographics
NPI:1124370333
Name:WOLF, HOLLY HAWKINS (PA-C)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:HAWKINS
Last Name:WOLF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6454 W. EMERALD ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8734
Mailing Address - Country:US
Mailing Address - Phone:208-377-0820
Mailing Address - Fax:208-375-8046
Practice Address - Street 1:13176 W. PERSIMMON LANE
Practice Address - Street 2:SUITE 100
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-5063
Practice Address - Country:US
Practice Address - Phone:208-377-0820
Practice Address - Fax:208-375-8046
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA1252363A00000X
OH50363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant