Active NPI
Holly Raymond, CNP
- Pediatric Nurse Practitioner
- Plymouth, MI
National Provider Identifier
1407908320
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- 4704150545
- Practice address
- 990 W Ann Arbor TRL
Suite 210
Plymouth, MI 48170-6204 - Phone
- (734) 455-4600
- Fax
- (734) 455-5637
- NPI assigned
- Jan 18, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 4704150545 | MI | Primary |
Addresses
Primary practice location
990 W Ann Arbor TRL
Suite 210
Plymouth, MI 48170-6204
Mailing address
2100 Commonwealth Blvd
Suite 202
Ann Arbor, MI 48105-1593
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
- Certified Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704150545 | MI | MD | Pediatric Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1407908320",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2100 COMMONWEALTH BLVD",
"address_2": "SUITE 202",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481051593"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "990 W ANN ARBOR TRL",
"address_2": "SUITE 210",
"city": "PLYMOUTH",
"state": "MI",
"postal_code": "481706204",
"telephone_number": "734-455-4600",
"fax_number": "734-455-5637"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAYMOND",
"first_name": "HOLLY",
"credential": "CNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "MI",
"license": "4704150545",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.