Healthcare Provider Details

I. General information

NPI: 1366948663
Provider Name (Legal Business Name): HOLLY AHLERS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HOLLY STURZENBECHER CNP

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 08/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S. SUMMIT AVE SIOUX FALLS, SD 57105
SIOUX FALLS SD
57105
US

IV. Provider business mailing address

2000 S SUMMIT AVE
SIOUX FALLS SD
57105-2727
US

V. Phone/Fax

Practice location:
  • Phone: 605-271-2325
  • Fax: 605-271-2491
Mailing address:
  • Phone: 605-271-2325
  • Fax: 605-271-2491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR034644
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCP001610
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: