Provider Demographics
NPI:1225575301
Name:HOLLENBECK, DONAVAN
Entity Type:Individual
Prefix:
First Name:DONAVAN
Middle Name:
Last Name:HOLLENBECK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:STAR PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:54026-0155
Mailing Address - Country:US
Mailing Address - Phone:715-417-2055
Mailing Address - Fax:
Practice Address - Street 1:473 222ND AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:WI
Practice Address - Zip Code:54025-7331
Practice Address - Country:US
Practice Address - Phone:715-417-2055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No376J00000XNursing Service Related ProvidersHomemaker