Healthcare Provider Details

I. General information

NPI: 1912418542
Provider Name (Legal Business Name): HOLLY FRANCES ALLEN BS & MSPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HOLLY FRANCES RULOFSON BS

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2706 ANKENY WAY
ROCK SPRINGS WY
82901-5649
US

IV. Provider business mailing address

2706 ANKENY WAY
ROCK SPRINGS WY
82901-5649
US

V. Phone/Fax

Practice location:
  • Phone: 307-352-6677
  • Fax:
Mailing address:
  • Phone: 307-352-6677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPPC-1060
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC1962
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: