MEDICARE: KAYLA HOLZER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R40807	ND

General Provider Information

NPI Number	:	1649901869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA HOLZER

Provider Business Mailing Address
First Line	:	209 W WACHTER AVE
Second Line	:
City	:	BISMARCK
State	:	ND
Zip	:	58504-7081
Country	:	US
Telephone Number	:	701-426-5603
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 N 9TH ST
Second Line	:
City	:	BISMARCK
State	:	ND
Zip	:	58501-4506
Country	:	US
Telephone Number	:	701-712-4500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2022
Last Update Date	:	06/14/2023

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Directions to “ KAYLA HOLZER ” Practice Location

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