Basic Information
| Provider Information | |||||||||
| NPI: | 1538578653 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEAHY | ||||||||
| FirstName: | HOLLY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | APNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2901 W KINNICKINNIC RIVER PKWY | ||||||||
| Address2: | SUITE 315 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532153677 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4146495646 | ||||||||
| FaxNumber: | 4146496282 | ||||||||
| Practice Location | |||||||||
| Address1: | 2901 W KINNICKINNIC RIVER PKWY | ||||||||
| Address2: | SUITE 315 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532153677 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4146495646 | ||||||||
| FaxNumber: | 4146496282 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2014 | ||||||||
| LastUpdateDate: | 11/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 5872 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.