Healthcare Provider Details

I. General information

NPI: 1083814958
Provider Name (Legal Business Name): MICHELLE L HOLMES RN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 LONDON RD STE 102 ESSENTIA HEALTH LAKEWALK CLINIC
DULUTH MN
55812-1787
US

IV. Provider business mailing address

1502 LONDON RD STE 102 ESSENTIA HEALTH LAKEWALK CLINIC
DULUTH MN
55812-1787
US

V. Phone/Fax

Practice location:
  • Phone: 218-576-0100
  • Fax: 218-576-0126
Mailing address:
  • Phone: 218-576-0100
  • Fax: 218-576-0126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR131623-0
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: