Individual
HOLLY D'LANA VON GRUENIGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
404 STEVE DR, RUSSELL SPRINGS, KY 42642-4622
(270) 866-3161
(270) 866-3163
Mailing address
PO BOX 1080, BURKESVILLE, KY 42717-1080
(270) 864-1472
(270) 864-1693
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
03704
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100248610
—
KY
Enumeration date
05/16/2011
Last updated
09/19/2019
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