Provider Demographics
NPI:1912470907
Name:HOLLINGSHED, AUSTYN DESEAN
Entity Type:Individual
Prefix:MR
First Name:AUSTYN
Middle Name:DESEAN
Last Name:HOLLINGSHED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 HUSTLER ST
Mailing Address - Street 2:
Mailing Address - City:GWINN
Mailing Address - State:MI
Mailing Address - Zip Code:49841-2902
Mailing Address - Country:US
Mailing Address - Phone:906-251-1596
Mailing Address - Fax:
Practice Address - Street 1:485 HUSTLER ST
Practice Address - Street 2:
Practice Address - City:GWINN
Practice Address - State:MI
Practice Address - Zip Code:49841-2902
Practice Address - Country:US
Practice Address - Phone:906-251-1596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH452074139741OtherDRIVERS LICENSE
MI0022819320OtherUPHP0022