Active NPI
Holly Anne Light, R.N.
- Registered Nurse
- Plymouth, MI
National Provider Identifier
1033706015
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 4704187460
- Practice address
- 1400 S Sheldon Rd
Plymouth, MI 48170-2140 - Phone
- (734) 453-5807
- NPI assigned
- Dec 24, 2020
- Last updated
- Dec 24, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 4704187460 | MI | Primary |
Addresses
Primary practice location
1400 S Sheldon Rd
Plymouth, MI 48170-2140
Mailing address
21110 Woodland Glen Dr Apt 202
Northville, MI 48167-2445
Phone (734) 751-5158
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | lightholly@hotmail.com | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704187460 | MI | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Woodward Detroit CVS, L.L.C. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1608768000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1608768000000",
"number": "1033706015",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21110 WOODLAND GLEN DR APT 202",
"city": "NORTHVILLE",
"state": "MI",
"postal_code": "481672445",
"telephone_number": "734-751-5158"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 S SHELDON RD",
"city": "PLYMOUTH",
"state": "MI",
"postal_code": "481702140",
"telephone_number": "734-453-5807"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIGHT",
"first_name": "HOLLY",
"middle_name": "ANNE",
"credential": "R.N.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-12-24",
"last_updated": "2020-12-24",
"certification_date": "2020-12-24",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MI",
"license": "4704187460",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "lightholly@hotmail.com",
"affiliation": "N",
"endpointDescription": "email",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "21110 Woodland Glen Dr Apt 202",
"city": "Northville",
"state": "MI",
"country_code": "US",
"postal_code": "481672445",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Plymouth, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.