Provider Demographics
NPI:1497940522
Name:HOLLE, NED ARMIN (LIC AC MOM)
Entity Type:Individual
Prefix:MR
First Name:NED
Middle Name:ARMIN
Last Name:HOLLE
Suffix:
Gender:M
Credentials:LIC AC MOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5009 13TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-1118
Mailing Address - Country:US
Mailing Address - Phone:612-822-8207
Mailing Address - Fax:
Practice Address - Street 1:5009 13TH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-1118
Practice Address - Country:US
Practice Address - Phone:612-822-8207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1035171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist