Provider Demographics
NPI:1336817469
Name:HERZFELD-VAN DYKE, HOLLY ANN (RD,MS,LD,CDE)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:ANN
Last Name:HERZFELD-VAN DYKE
Suffix:
Gender:F
Credentials:RD,MS,LD,CDE
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 1811
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72033-1811
Mailing Address - Country:US
Mailing Address - Phone:501-818-9060
Mailing Address - Fax:
Practice Address - Street 1:3230-1 LIZZY LANE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032
Practice Address - Country:US
Practice Address - Phone:501-818-9060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-02
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR0783133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic