Healthcare Provider Details

I. General information

NPI: 1881695229
Provider Name (Legal Business Name): HOLLY E. HERTEL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 03/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 KS HWY 264
LARNED KS
67550-5353
US

IV. Provider business mailing address

1301 KS HWY 264
LARNED KS
67550-5353
US

V. Phone/Fax

Practice location:
  • Phone: 620-285-4507
  • Fax: 620-285-4509
Mailing address:
  • Phone: 620-285-4507
  • Fax: 620-285-4509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number45260
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: