Healthcare Provider Details

I. General information

NPI: 1003315789
Provider Name (Legal Business Name): HOLLY MARIE HEYNE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. HOLLY COLLINS

II. Dates (important events)

Enumeration Date: 02/07/2018
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7173 E SUPER 1 LOOP STE B
ATHOL ID
83801
US

IV. Provider business mailing address

1593 E POLSTON AVE
POST FALLS ID
83854-5326
US

V. Phone/Fax

Practice location:
  • Phone: 208-561-9901
  • Fax: 208-561-9968
Mailing address:
  • Phone: 208-262-2300
  • Fax: 208-262-2390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number59037
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number47201
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: