Healthcare Provider Details

I. General information

NPI: 1245510700
Provider Name (Legal Business Name): LESLEY RAE HOLMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2011
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 CENTRACARE CIR
SAINT CLOUD MN
56303-5000
US

IV. Provider business mailing address

1900 CENTRACARE CIR
SAINT CLOUD MN
56303-5000
US

V. Phone/Fax

Practice location:
  • Phone: 320-229-4900
  • Fax: 320-229-5160
Mailing address:
  • Phone: 320-229-4900
  • Fax: 320-229-5160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR 168265-0
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: