Healthcare Provider Details

I. General information

NPI: 1447084900
Provider Name (Legal Business Name): KATERINA ROSE HOLMEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2024
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 306
POWERS LAKE ND
58773-0306
US

IV. Provider business mailing address

PO BOX 306
POWERS LAKE ND
58773-0306
US

V. Phone/Fax

Practice location:
  • Phone: 701-641-2720
  • Fax:
Mailing address:
  • Phone: 701-641-2720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: