MEDICARE: MRS. CAROL L HOLTON FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	MNR1219298	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043287527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROL L HOLTON FNP

Provider Business Mailing Address
First Line	:	37 COLLEGE AVE S
Second Line	:	3COLLEGE OF ST. BENEDICT - LOOTIE HALL
City	:	SAINT JOSEPH
State	:	MN
Zip	:	56374-2001
Country	:	US
Telephone Number	:	320-363-5605
Fax Number	:	320-363-6396

Provider Business Practice Location Address
First Line	:	37 COLLEGE AVE SOUTH
Second Line	:
City	:	SAINT JOSEPH
State	:	MN
Zip	:	56374
Country	:	US
Telephone Number	:	320-363-5605
Fax Number	:	320-363-6396

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2006
Last Update Date	:	11/04/2010

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