Healthcare Provider Details

I. General information

NPI: 1568681534
Provider Name (Legal Business Name): TERRI LYNN HOLM RN CWOCN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 DELLWOOD ST S
CAMBRIDGE MN
55008-1920
US

IV. Provider business mailing address

701 DELLWOOD ST S
CAMBRIDGE MN
55008-1920
US

V. Phone/Fax

Practice location:
  • Phone: 763-689-7782
  • Fax: 763-689-7716
Mailing address:
  • Phone: 763-689-7782
  • Fax: 763-689-7716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0900X
TaxonomyEnterostomal Therapy Registered Nurse
License NumberR 106112-9
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: