Healthcare Provider Details
I. General information
NPI: 1821572090
Provider Name (Legal Business Name): DANIELLE LYNN HOLSTEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 09/24/2018
Last Update Date: 12/26/2023
Certification Date: 12/26/2023
Deactivation Date:
Reactivation Date:
III. Provider practice location address
400 BURDICK EXPY E
MINOT ND
58701-4768
US
IV. Provider business mailing address
PO BOX 5010
MINOT ND
58702-5010
US
V. Phone/Fax
- Phone: 701-857-7383
- Fax: 701-857-7013
- Phone: 701-418-8000
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| License Number | R39125 |
| License Number State | ND |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: