Healthcare Provider Details

I. General information

NPI: 1215298914
Provider Name (Legal Business Name): PAMELA K HOLWEGNER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAMELA K PEARSON

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 S BROADWAY
MINOT ND
58701-4636
US

IV. Provider business mailing address

PO BOX 5010
MINOT ND
58702-5010
US

V. Phone/Fax

Practice location:
  • Phone: 701-857-3535
  • Fax: 701-857-5171
Mailing address:
  • Phone: 701-857-5650
  • Fax: 701-857-5031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR25646
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: