Healthcare Provider Details

I. General information

NPI: 1275769226
Provider Name (Legal Business Name): HOLLY L. GERHARD RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2009
Last Update Date: 07/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 W WASHINGTON AVE SUITE 100
MADISON WI
53703-2996
US

IV. Provider business mailing address

202 S PARK ST
MADISON WI
53715-1507
US

V. Phone/Fax

Practice location:
  • Phone: 608-417-8300
  • Fax:
Mailing address:
  • Phone: 608-417-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2179-29
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: