Provider Demographics
NPI:1699014043
Name:HENGSTENBERGER, HOLLY MARIE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:MARIE
Last Name:HENGSTENBERGER
Suffix:
Gender:F
Credentials:CRNA
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 77033
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44194-7033
Mailing Address - Country:US
Mailing Address - Phone:440-350-0832
Mailing Address - Fax:440-354-7420
Practice Address - Street 1:40 W ERIE ST
Practice Address - Street 2:SUITE 203
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-3274
Practice Address - Country:US
Practice Address - Phone:440-350-0832
Practice Address - Fax:440-354-7420
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.13883-NA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered