Provider Demographics
NPI:1487619250
Name:HOLLAND, KRISTEN L (MD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:L
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 NORTH SUNRISE DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ST. PETER
Mailing Address - State:MN
Mailing Address - Zip Code:56082
Mailing Address - Country:US
Mailing Address - Phone:507-931-2110
Mailing Address - Fax:507-931-9409
Practice Address - Street 1:1900 NORTH SUNRISE DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ST. PETER
Practice Address - State:MN
Practice Address - Zip Code:56082
Practice Address - Country:US
Practice Address - Phone:507-931-2110
Practice Address - Fax:507-931-9409
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20794207Q00000X
SD4346207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5610280Medicaid
SD5367Medicare ID - Type Unspecified
SD5610280Medicaid