Healthcare Provider Details

I. General information

NPI: 1174800569
Provider Name (Legal Business Name): HOLLIE STEFFENS DONNELLY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2011
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 2ND AVE
LAKE CHARLES LA
70601-8906
US

IV. Provider business mailing address

PO BOX 122539 DEPT 2539
DALLAS TX
75312-0001
US

V. Phone/Fax

Practice location:
  • Phone: 337-480-8994
  • Fax: 337-480-8993
Mailing address:
  • Phone: 337-494-2772
  • Fax: 337-494-2928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN094646-AP06583
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: