Provider Demographics
NPI:1710546957
Name:HOELZEMAN, MALLORY DENAE (APRN)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:DENAE
Last Name:HOELZEMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 FOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-3684
Mailing Address - Country:US
Mailing Address - Phone:501-328-0055
Mailing Address - Fax:501-328-2194
Practice Address - Street 1:3010 FOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-3684
Practice Address - Country:US
Practice Address - Phone:501-328-0055
Practice Address - Fax:501-328-2194
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR120120363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR120120OtherARKANSAS NURSE PRACTITIONER LICENSE
F06190767OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION BOARD