Healthcare Provider Details

I. General information

NPI: 1174599450
Provider Name (Legal Business Name): KRISTIN A HOLM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 NORTH ST
WATERVILLE ME
04901-4974
US

IV. Provider business mailing address

149 NORTH ST
WATERVILLE ME
04901-4974
US

V. Phone/Fax

Practice location:
  • Phone: 207-872-1715
  • Fax: 207-872-1725
Mailing address:
  • Phone: 207-872-1715
  • Fax: 207-872-1725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number014498
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: