Individual
MR. AUSTYN DESEAN HOLLINGSHED
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
485 HUSTLER ST, GWINN, MI 49841-2902
(906) 251-1596
Mailing address
485 HUSTLER ST, GWINN, MI 49841-2902
(906) 251-1596
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0022819320
UPHP0022
MI
01
—
H452074139741
DRIVERS LICENSE
MI
Enumeration date
01/02/2019
Last updated
01/02/2019
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