Basic Information
| Provider Information | |||||||||
| NPI: | 1396806279 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLLIS | ||||||||
| FirstName: | SAMANTHA | ||||||||
| MiddleName: | ELAN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MMS, PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4755 OGLETOWN STANTON RD | ||||||||
| Address2: | SUITE 2E99 | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197182200 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4755 OGLETOWN STANTON RD | ||||||||
| Address2: | SUITE 2E99 | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197182200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3027335982 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| LastUpdateDate: | 12/05/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 085002891 | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 207P00000X | C5-0000632 | DE | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 363A00000X | C5-0000891 | DE | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.