Provider Demographics
NPI:1326700360
Name:GIRDEEN, HOLLY CATHERINE (NP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:CATHERINE
Last Name:GIRDEEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W3719 330TH AVE
Mailing Address - Street 2:
Mailing Address - City:MAIDEN ROCK
Mailing Address - State:WI
Mailing Address - Zip Code:54750-8900
Mailing Address - Country:US
Mailing Address - Phone:715-220-8711
Mailing Address - Fax:
Practice Address - Street 1:W3719 330TH AVE
Practice Address - Street 2:
Practice Address - City:MAIDEN ROCK
Practice Address - State:WI
Practice Address - Zip Code:54750-8900
Practice Address - Country:US
Practice Address - Phone:715-220-8711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNAG08210126363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care