Provider Demographics
NPI:1215917216
Name:LEVINE, HOLLY KRISTINE (MD)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:KRISTINE
Last Name:LEVINE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:720 4TH AVE S
Mailing Address - Street 2:STUDENT HEALTH SERVICE
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-4442
Mailing Address - Country:US
Mailing Address - Phone:320-308-4856
Mailing Address - Fax:320-308-3192
Practice Address - Street 1:720 4TH AVE S
Practice Address - Street 2:STUDENT HEALTH SERVICE
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-4442
Practice Address - Country:US
Practice Address - Phone:320-308-4856
Practice Address - Fax:320-308-3192
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2007-10-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN46257207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN124981Medicare UPIN