Provider Demographics
NPI:1699971978
Name:PAUTZ, HOLLY LYNN (PA - C)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:LYNN
Last Name:PAUTZ
Suffix:
Gender:F
Credentials:PA - C
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:L
Other - Last Name:VANZEELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7210
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:964 W RYAN ST
Practice Address - Street 2:SUITE B
Practice Address - City:BRILLION
Practice Address - State:WI
Practice Address - Zip Code:54110-1076
Practice Address - Country:US
Practice Address - Phone:920-756-2055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2141363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1077801OtherNATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS
1077801OtherNATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS
MP1598397OtherDEA
000069Medicare Oscar/Certification
P00697635Medicare Oscar/Certification
000036Medicare Oscar/Certification
WIK400197507Medicare Oscar/Certification