Provider Demographics
NPI:1588055842
Name:HOLTHUS, STEPHANIE CHRISTINE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:CHRISTINE
Last Name:HOLTHUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10075 S GULL LAKE RD NE
Mailing Address - Street 2:
Mailing Address - City:TENSTRIKE
Mailing Address - State:MN
Mailing Address - Zip Code:56683-2083
Mailing Address - Country:US
Mailing Address - Phone:507-469-2545
Mailing Address - Fax:
Practice Address - Street 1:1833 W US HIGHWAY 2 # G
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-4736
Practice Address - Country:US
Practice Address - Phone:507-469-2545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-09
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
MN1107176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula