Healthcare Provider Details

I. General information

NPI: 1003262734
Provider Name (Legal Business Name): KATHLEEN SUE HOLETS APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2016
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 COUNTY ROAD B2 W SUITE 64
ROSEVILLE MN
55113-2729
US

IV. Provider business mailing address

1058 BARRETT ST
SAINT PAUL MN
55103-1313
US

V. Phone/Fax

Practice location:
  • Phone: 612-465-9270
  • Fax:
Mailing address:
  • Phone: 651-600-7715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCNP4522
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR1226317
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: