Individual
MS. HOLLY HUSTED
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
803 W ARLINGTON ST, BANGOR, MI 49013-1108
(269) 427-6810
(269) 657-6523
Mailing address
801 HAZEN ST STE C, PAW PAW, MI 49079-2008
(269) 655-3334
(269) 657-6523
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704199043
MI
363LW0102X
Women's Health Nurse Practitioner
4704199043
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1750438214
—
MI
01
—
1801818752
BCBSM - BMG
MI
Enumeration date
01/05/2007
Last updated
03/12/2019
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