Provider Demographics
NPI:1881695229
Name:HERTEL, HOLLY E (ARNP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:E
Last Name:HERTEL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 KS HWY 264
Mailing Address - Street 2:
Mailing Address - City:LARNED
Mailing Address - State:KS
Mailing Address - Zip Code:67550-5353
Mailing Address - Country:US
Mailing Address - Phone:620-285-4507
Mailing Address - Fax:620-285-4509
Practice Address - Street 1:1301 KS HWY 264
Practice Address - Street 2:
Practice Address - City:LARNED
Practice Address - State:KS
Practice Address - Zip Code:67550-5353
Practice Address - Country:US
Practice Address - Phone:620-285-4507
Practice Address - Fax:620-285-4509
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45260363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100413870AMedicaid
KS160749OtherBLUE SHIELD
KS161890Medicare PIN
KSP49745Medicare UPIN
KS160749Medicare ID - Type Unspecified