Provider Demographics
NPI:1255392981
Name:HOLCK, SHEROL L (NP)
Entity type:Individual
Prefix:
First Name:SHEROL
Middle Name:L
Last Name:HOLCK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SHEROL
Other - Middle Name:L
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WCC
Mailing Address - Street 1:PO BOX 43
Mailing Address - Street 2:MR 10809
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55440-0043
Mailing Address - Country:US
Mailing Address - Phone:612-262-4813
Mailing Address - Fax:612-262-4194
Practice Address - Street 1:1210 1ST ST W
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-1147
Practice Address - Country:US
Practice Address - Phone:651-438-1800
Practice Address - Fax:651-438-1894
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIR0754602163WG0600X
WI133811363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WG0600XNursing Service ProvidersRegistered NurseGerontology
Not Answered363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01444Medicare UPIN