Provider Demographics
NPI:1770735219
Name:HOLLENKAMP, EMILY MADELYN (RN, CPNP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:MADELYN
Last Name:HOLLENKAMP
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Gender:F
Credentials:RN, CPNP
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Mailing Address - Street 1:4600 MEMORIAL DR STE G60
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-5368
Mailing Address - Country:US
Mailing Address - Phone:618-257-2550
Mailing Address - Fax:618-257-2569
Practice Address - Street 1:4600 MEMORIAL DR STE G60
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5368
Practice Address - Country:US
Practice Address - Phone:618-257-2550
Practice Address - Fax:618-257-2569
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2003016022363LP0200X
IL209.008369041.343530363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics