| NPI | 1104229103 |
|---|---|
| Former Name | HOLLY LYNN OTTAVIANO AND REVELES |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95000536) |
| Enumeration Date | 2014-10-03 |
| Last Update Date | 2014-10-03 |