Provider Demographics
NPI:1003197997
Name:HERSHBERGER, HOLLY JO (FNP-BC)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:JO
Last Name:HERSHBERGER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:JO
Other - Last Name:KITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:37868 US HIGHWAY 18
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU CHIEN
Mailing Address - State:WI
Mailing Address - Zip Code:53821-8416
Mailing Address - Country:US
Mailing Address - Phone:608-357-2000
Mailing Address - Fax:608-357-2254
Practice Address - Street 1:37868 US HIGHWAY 18
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU CHIEN
Practice Address - State:WI
Practice Address - Zip Code:53821-8416
Practice Address - Country:US
Practice Address - Phone:608-357-2000
Practice Address - Fax:608-357-2254
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4533-033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4533-033OtherSTATE OF WISCONSIN DEPT OF REGULATION AND LICENSING