Healthcare Provider Details

I. General information

NPI: 1447925755
Provider Name (Legal Business Name): MINNESOTA HOLISTIC CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25282 HAZELWOOD DR UNIT 1
NISSWA MN
56468-2797
US

IV. Provider business mailing address

25282 HAZELWOOD DR UNIT 1
NISSWA MN
56468-2797
US

V. Phone/Fax

Practice location:
  • Phone: 651-410-7955
  • Fax:
Mailing address:
  • Phone: 651-410-7955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: APRIL STARLLONE
Title or Position: CEO
Credential: PMHNP
Phone: 651-410-7955