Healthcare Provider Details

I. General information

NPI: 1093622391
Provider Name (Legal Business Name): HOLLY NIGON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15770 18TH ST NE
LITTLE FALLS MN
56345-0008
US

IV. Provider business mailing address

15770 18TH ST NE
LITTLE FALLS MN
56345-0008
US

V. Phone/Fax

Practice location:
  • Phone: 320-631-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10275
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: