Holly Edson, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95015996 Issued in CA

Practice address

4340 Redwood Hwy Ste a-22
San Rafael, CA 94903-2121

Phone

(415) 509-5493

NPI assigned

Nov 19, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Preventive Medical Center of Marin Inc

  • Primary Care Clinic/Center
  • San Rafael, CA
  • NPI 1912067828
  Medicare reassignment NPD
• Rasnow Integrative Wellness Inc

  • Multi-Specialty Clinic/Center
  • Sacramento, CA
  • NPI 1801438015
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1605744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605744000000",
    "number": "1053914176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4340 REDWOOD HWY STE A-22",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949032121",
            "telephone_number": "415-472-2343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4340 REDWOOD HWY STE A-22",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949032121",
            "telephone_number": "415-509-5493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDSON",
        "first_name": "HOLLY",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-19",
        "last_updated": "2020-11-19",
        "certification_date": "2020-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95015996",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ecumenical Association for Housing, Inc.
• Tracie L Eddington-Bailey, LCSW
• Evan Edelist
• Edgar Celis MD Inc
• Sara Abbot Edrington, PSYD
• Alexander Edwards, MS CCC SLP
• Damian Alfonso Edwards, CASE 1
• Mark Anthony Edwards, MS, MFT
• Rochelle Edwards, LMFT
• Boukje Elisabeth Eerkens, PSY.D.

• Family Nurse Practitioner in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.