Healthcare Provider Details

I. General information

NPI: 1588055842
Provider Name (Legal Business Name): STEPHANIE CHRISTINE HOLTHUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2015
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1833 W US HIGHWAY 2 # G
GRAND RAPIDS MN
55744-4736
US

IV. Provider business mailing address

10075 S GULL LAKE RD NE
TENSTRIKE MN
56683-2083
US

V. Phone/Fax

Practice location:
  • Phone: 507-469-2545
  • Fax:
Mailing address:
  • Phone: 507-469-2545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number1107
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: