Provider Demographics
NPI:1982686580
Name:HOLLEY, MICHELE MONIQUE (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:MONIQUE
Last Name:HOLLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7096
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-0096
Mailing Address - Country:US
Mailing Address - Phone:209-956-7725
Mailing Address - Fax:209-956-7733
Practice Address - Street 1:2735 SILVER CREEK ROAD
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7942
Practice Address - Country:US
Practice Address - Phone:928-763-2273
Practice Address - Fax:928-763-0223
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4974207L00000X
AZ36011207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ167812Medicare PIN
TXI02292Medicare UPIN
AZP01346090Medicare PIN