Healthcare Provider Details

I. General information

NPI: 1972065084
Provider Name (Legal Business Name): KATHLEEN HOLSAETER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6655 S CIMARRON RD STE 100
LAS VEGAS NV
89113-2181
US

IV. Provider business mailing address

1494 KALANIIKI ST
HONOLULU HI
96821-1216
US

V. Phone/Fax

Practice location:
  • Phone: 702-853-3561
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number011189
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number011189
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberDOS-2722-0
License Number StateHI
# 4
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberDOS-2722-0
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: