Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | R 122631 7 | MN |
Y | 363LG0600X | Nurse Practitioner - Gerontology | R 122631 7 | MN |
NPI | 1003262734 |
---|---|
Provider Name | Kathleen Sue Holets |
First Address | Saint Paul, MN 55103-1313 |
Second Address | Roseville, MN 55113-2729 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2016 |
Last Update Date | 12/05/2016 |