Provider Demographics
NPI:1275984700
Name:PINE HOLLOW PARTNER LLC
Entity Type:Organization
Organization Name:PINE HOLLOW PARTNER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ZINK
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:517-339-1676
Mailing Address - Street 1:6200 PINE HOLLOW DR
Mailing Address - Street 2:STE 400
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-9700
Mailing Address - Country:US
Mailing Address - Phone:517-339-1676
Mailing Address - Fax:517-339-2716
Practice Address - Street 1:6200 PINE HOLLOW DR
Practice Address - Street 2:STE 400
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-9700
Practice Address - Country:US
Practice Address - Phone:517-339-1676
Practice Address - Fax:517-339-2716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-27
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty