Basic Information
Provider Information
NPI: 1003141482
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MALEY
FirstName: HOLLY
MiddleName: ANN
NamePrefix: MRS.
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 409 S 2ND ST
Address2: SUITE 2F
City: HARRISBURG
State: PA
PostalCode: 171041612
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 111 S FRONT ST
Address2:  
City: HARRISBURG
State: PA
PostalCode: 171012010
CountryCode: US
TelephoneNumber: 7177825118
FaxNumber: 7177825854
Other Information
ProviderEnumerationDate: 10/02/2009
LastUpdateDate: 12/19/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000XRN546877PAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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