Provider Demographics
NPI:1306459417
Name:NICHOLSON, HOLLY BEHR (APRN)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:BEHR
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4016 RIVER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-6673
Mailing Address - Country:US
Mailing Address - Phone:843-742-7922
Mailing Address - Fax:
Practice Address - Street 1:4016 RIVER OAKS DR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-6673
Practice Address - Country:US
Practice Address - Phone:843-742-7922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23572208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation