Provider Demographics
NPI:1841339405
Name:HOLLENBACK, MARY ANN (APN)
Entity type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:HOLLENBACK
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 OGDEN AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-5898
Mailing Address - Country:US
Mailing Address - Phone:630-692-5563
Mailing Address - Fax:630-692-5564
Practice Address - Street 1:2020 OGDEN AVE STE 400
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-5898
Practice Address - Country:US
Practice Address - Phone:630-692-5563
Practice Address - Fax:630-692-5564
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277-000554363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL5966OtherMEDICARE PTAN (GROUP)
ILIL5966004OtherMEDICARE PTAN (INDIVIDUAL)
IL$$$$$$$$$001Medicaid