Healthcare Provider Details

I. General information

NPI: 1184143232
Provider Name (Legal Business Name): MICHELE OLIVIA HOELLEIN PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELE OLIVIA ROGERS

II. Dates (important events)

Enumeration Date: 09/10/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S STATE ST STE 113
ABERDEEN SD
57401-4502
US

IV. Provider business mailing address

PO BOX 1460
ABERDEEN SD
57402-1460
US

V. Phone/Fax

Practice location:
  • Phone: 605-225-0378
  • Fax:
Mailing address:
  • Phone: 605-622-2876
  • Fax: 605-622-2804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1114
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: