Provider Demographics
NPI:1215148366
Name:HOLTEN, SANDRA LYNN (MT-BC, NMT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYNN
Last Name:HOLTEN
Suffix:
Gender:F
Credentials:MT-BC, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5465 VINEWOOD LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55442-1766
Mailing Address - Country:US
Mailing Address - Phone:763-557-0168
Mailing Address - Fax:
Practice Address - Street 1:6701 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4602
Practice Address - Country:US
Practice Address - Phone:952-993-6061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist