Healthcare Provider Details

I. General information

NPI: 1538365895
Provider Name (Legal Business Name): HOLLY ANN HINK II APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1252 N 22ND ST
LARAMIE WY
82072-5306
US

IV. Provider business mailing address

4605 N COLLEGE DR
CHEYENNE WY
82009-5455
US

V. Phone/Fax

Practice location:
  • Phone: 307-745-3704
  • Fax: 307-745-7237
Mailing address:
  • Phone: 307-459-5437
  • Fax: 307-448-3429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1762
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberA01807
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: