Healthcare Provider Details

I. General information

NPI: 1508131046
Provider Name (Legal Business Name): LAURA ANN HOLST DNP, ANESTHESIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2012
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 E RUSHOLME ST
DAVENPORT IA
52803-2459
US

IV. Provider business mailing address

PO BOX 1245
BETTENDORF IA
52722-0021
US

V. Phone/Fax

Practice location:
  • Phone: 563-324-8160
  • Fax:
Mailing address:
  • Phone: 563-562-0525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberD112161
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: