Provider Demographics
NPI:1528222197
Name:BEAULIEU, HOLLY LYNE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:HOLLY
Middle Name:LYNE
Last Name:BEAULIEU
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:PO BOX 14909
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-0909
Mailing Address - Country:US
Mailing Address - Phone:612-871-1145
Mailing Address - Fax:612-870-5491
Practice Address - Street 1:1973 SLOAN PL STE 100
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55117
Practice Address - Country:US
Practice Address - Phone:651-241-5593
Practice Address - Fax:651-241-5870
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2018-08-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN10419363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical