Individual
MRS. HOLLY MARIE HEYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
7173 E SUPER 1 LOOP, STE B, ATHOL, ID 83801
(208) 561-9901
(208) 561-9968
Mailing address
1593 E POLSTON AVE, POST FALLS, ID 83854-5326
(208) 262-2300
(208) 262-2390
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
47201
ID
363LF0000X
Family Nurse Practitioner
Primary
59037
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003315789
—
ID
Enumeration date
02/07/2018
Last updated
12/20/2024
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