Healthcare Provider Details

I. General information

NPI: 1013791581
Provider Name (Legal Business Name): HOLLY CARRIZALES FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HOLLY SAUER

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 BLUE STAR HWY
SOUTH HAVEN MI
49090-7758
US

IV. Provider business mailing address

940 BLUE STAR HWY
SOUTH HAVEN MI
49090-7758
US

V. Phone/Fax

Practice location:
  • Phone: 269-639-2976
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704328731
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704328731
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: