Healthcare Provider Details

I. General information

NPI: 1003197997
Provider Name (Legal Business Name): HOLLY JO HERSHBERGER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HOLLY JO KITE

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37868 US HIGHWAY 18
PRAIRIE DU CHIEN WI
53821-8416
US

IV. Provider business mailing address

37868 US HIGHWAY 18
PRAIRIE DU CHIEN WI
53821-8416
US

V. Phone/Fax

Practice location:
  • Phone: 608-357-2000
  • Fax: 608-357-2254
Mailing address:
  • Phone: 608-357-2000
  • Fax: 608-357-2254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4533-033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: