Provider Demographics
NPI:1396175212
Name:REDA, HOLLIE M (PA)
Entity type:Individual
Prefix:MRS
First Name:HOLLIE
Middle Name:M
Last Name:REDA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:HOLLIE
Other - Middle Name:M
Other - Last Name:METCALFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4323 INTEGRITY CENTER PT
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-1683
Practice Address - Country:US
Practice Address - Phone:719-591-2558
Practice Address - Fax:719-591-2596
Is Sole Proprietor?:No
Enumeration Date:2013-11-13
Last Update Date:2021-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.005785363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant