Provider Demographics
NPI:1891058061
Name:STAPLEY, HOLLIE MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:HOLLIE
Middle Name:MARIE
Last Name:STAPLEY
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 1:280 N HOSPITAL DR
Mailing Address - Street 2:SUITE #2
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-4216
Mailing Address - Country:US
Mailing Address - Phone:435-613-2229
Mailing Address - Fax:435-613-2230
Practice Address - Street 1:280 N HOSPITAL DR
Practice Address - Street 2:SUITE #2
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-4216
Practice Address - Country:US
Practice Address - Phone:435-613-2229
Practice Address - Fax:435-613-2230
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT83528071206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
12291982OtherDOB